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  1. Article ; Online: Antibiotic prophylaxis in acute childhood leukemia: What is known so far?

    Dufrayer, Mauro Cesar / Monteiro, Yasmine Massaro Carneiro / Carlesse, Fabianne Altruda de Moraes Costa / Motta, Fabrizio / Daudt, Liane Esteves / Michalowski, Mariana Bohns

    Hematology, transfusion and cell therapy

    2022  Volume 45, Issue 4, Page(s) 473–482

    Abstract: Introduction: The treatment of acute lymphoblastic leukemia (ALL) has evolved in recent decades, reaching an overall survival rate close to 90%. Currently, approximately 4% of patients with ALL die from secondary complications of chemotherapy. Among ... ...

    Abstract Introduction: The treatment of acute lymphoblastic leukemia (ALL) has evolved in recent decades, reaching an overall survival rate close to 90%. Currently, approximately 4% of patients with ALL die from secondary complications of chemotherapy. Among these complications, the most frequent is febrile neutropenia (FN). The treatment of acute myeloid leukemias (AMLs) is even more aggressive, being consequently related to a considerable amount of treatment-related toxicity with a high risk of severe infection and death.
    Method: In order to reduce the infection-related risks in these groups of patients, systemic antibacterial prophylaxis has emerged as a possible approach.
    Results: Antibiotic prophylaxis during neutropenia periods in those undergoing chemotherapy have .already been proven in adults with acute leukemias (ALs). Among the possible available therapeutic options for bacterial prophylaxis in children with cancer, fluoroquinolones emerged with the most amount of evidence. Within this class, levofloxacin became the best choice.
    Conclusion: Therefore, the use of levofloxacin seems to be indicated in very specific situations: in children who are known to be neutropenic for a long time, secondary to intensive chemotherapy; in children with AL undergoing chemotherapy to induce remission; or in children undergoing hematopoietic stem cell transplantation (HSCT). This article aims to describe recent evidence focusing on antibiotic prophylaxis in children with ALs.
    Language English
    Publishing date 2022-11-21
    Publishing country Brazil
    Document type Journal Article ; Review
    ISSN 2531-1387
    ISSN (online) 2531-1387
    DOI 10.1016/j.htct.2022.09.1279
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Safety of levofloxacin as an antibiotic prophylaxis in the induction phase of children newly diagnosed with acute lymphoblastic leukemia: an interim analysis of a randomized, open-label trial in Brazil.

    Dufrayer, Mauro Cesar / Rechenmacher, Ciliana / Meneses, Clarice Franco / Monteiro, Yasmine Massaro Carneiro / Carlesse, Fabianne Altruda de Moraes Costa / Motta, Fabrizio / Daudt, Liane Esteves / Michalowski, Mariana Bohns

    The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases

    2023  Volume 27, Issue 2, Page(s) 102745

    Abstract: Background: Despite high cure rates, treatment-related mortality in children with acute lymphoblastic leukemia (ALL) remains significant. About 4% of patients die during remission induction therapy and approximately two-thirds of treatment-related ... ...

    Abstract Background: Despite high cure rates, treatment-related mortality in children with acute lymphoblastic leukemia (ALL) remains significant. About 4% of patients die during remission induction therapy and approximately two-thirds of treatment-related deaths are due to infectious complications.
    Methods: From May 2021 to June 2022, children aged one through 18 years, with a recent diagnosis of ALL, admitted to three pediatric oncology centers in Brazil, were enrolled in this multicenter, open-label, randomized, phase 3 clinical trial. Eligible patients were randomly divided into two groups, based on a 1:1 allocation ratio, to receive, or not, levofloxacin as a prophylactic agent during the induction phase. All patients were treated according to the IC-BFM 2009 chemotherapy protocol. Primary endpoints were carbapenemase-producing Enterobacteriaceae (CPE) colonization, Clostridioides difficile diarrhea, and other adverse events related to the use of levofloxacin. The secondary endpoint was febrile neutropenia during induction. The median follow-up was 289 days.
    Results: Twenty patients were included in this trial, 10 in each group (control and levofloxacin). Mild adverse reactions related to levofloxacin were observed in three patients (30%). Three patients had Clostridioides difficile diarrhea, two in the levofloxacin group and one in the control group (p > 0.99). Only one patient presented colonization by CPE. This patient belonged to the levofloxacin group (p > 0.99). Nine patients presented febrile neutropenia, five in the control group and four in the levofloxacin intervention group (p > 0.99), one patient died due to febrile neutropenia.
    Conclusion: The use of levofloxacin was shown to be safe in the induction phase in children with de novo ALL. The use of this medication did not increase the rate of colonization by CPE nor the rate of diarrhea by C. difficile. All adverse reactions were mild and remitted either spontaneously or after switching medicine administration from oral to intravenous route.
    MeSH term(s) Humans ; Child ; Adolescent ; Levofloxacin/adverse effects ; Antibiotic Prophylaxis/methods ; Anti-Bacterial Agents/adverse effects ; Clostridioides difficile ; Brazil ; Febrile Neutropenia/drug therapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications ; Diarrhea/complications ; Diarrhea/drug therapy
    Chemical Substances Levofloxacin (6GNT3Y5LMF) ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-02-05
    Publishing country Brazil
    Document type Randomized Controlled Trial ; Multicenter Study ; Clinical Trial, Phase III ; Journal Article
    ZDB-ID 2041400-6
    ISSN 1678-4391 ; 1413-8670
    ISSN (online) 1678-4391
    ISSN 1413-8670
    DOI 10.1016/j.bjid.2023.102745
    Database MEDical Literature Analysis and Retrieval System OnLINE

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