Meta-analysis finds fluoroquinolone prophylaxis reduces febrile neutropenia in pediatric ALL
Photo by Photostock Editor / Unsplash
Key Takeaway
Consider fluoroquinolone prophylaxis to reduce febrile neutropenia in pediatric ALL, but note no mortality benefit.
This systematic review and meta-analysis evaluated the efficacy of fluoroquinolone prophylaxis (levofloxacin or ciprofloxacin) versus no prophylaxis in children with acute lymphoblastic leukemia. The analysis included 991 patients, though the setting and follow-up duration were not reported. The primary outcome was febrile neutropenia, with secondary outcomes including bloodstream infection, Clostridioides difficile infection, and all-cause mortality.
Fluoroquinolone prophylaxis was associated with a significant reduction in febrile neutropenia (OR 0.44, 95% CI 0.33-0.59; absolute rates 46.1% vs 64.9%). Bloodstream infection was also reduced (OR 0.50, 95% CI 0.32-0.81). However, Clostridioides difficile infection (OR 0.43, 95% CI 0.00-42.30) and all-cause mortality (OR 1.04, 95% CI 0.20-5.38) were not significantly altered.
The authors note limitations including heterogeneous populations and a lack of analyses specific to the induction phase. Adverse events, tolerability, and funding sources were not reported. Overall mortality was unchanged, which tempers enthusiasm for routine prophylaxis.
For clinicians, these findings suggest fluoroquinolone prophylaxis may reduce infectious morbidity during pediatric ALL treatment, potentially improving treatment tolerance. However, the lack of mortality benefit and heterogeneity across studies warrant individualized decision-making and further research.
More on Acute Lymphoblastic Leukemia
Review of ESBL-producing E. coli epidemiology and fluoroquinolone resistance in Mexican community isolates
UTIs Are Getting Harder to Treat — Here’s Why
This retrospective cross-sectional study reviews community-acquired E.
This could change how doctors choose antibiotics for UTIs.
Lyophilized pegaspargase shows similar activity to liquid form in pediatric ALL
Lyophilized pegaspargase shows similar activity and safety to liquid form for pediatric leukemia patients
This phase 2 study in 89 pediatric ALL patients in Russia found that lyophilized pegaspargase had similar maximum plasma asparaginase activi…
A new form of pegaspargase works just like the liquid version for treating acute lymphoblastic leukemia in children in Russia.
Review of observational data on non-sedated MRI feasibility in newly diagnosed ALL patients ages 3 to 10 years
Non-sedated MRI scans work for young leukemia patients with practice
This review synthesizes observational data from a community setting involving 17 newly diagnosed ALL patients and 30 controls ages 3 to 10 y…
Young children with acute lymphoblastic leukemia can undergo non-sedated MRI scans. Success rates improve with repeated visits and behaviora…
Molecular epidemiology study of rifampicin-resistant TB in Vietnam shows high resistance to other drugs
Vietnam’s TB Crisis Hides a Dangerous Pattern
This molecular epidemiology study analyzed 252 rifampicin-resistant TB isolates from Vietnam using whole genome sequencing.
A hidden pattern in Vietnam’s tuberculosis cases reveals most drug-resistant strains also resist other key medicines, changing how doctors m…
View Original Abstract ↓
UNLABELLED: The role of infection prevention with fluoroquinolone prophylaxis specifically, during induction chemotherapy in pediatric acute lymphoblastic leukemia (ALL), remains unclear. Therefore, we conducted a systematic review and meta-analysis to assess its efficacy. PubMed, Scopus, and Cochrane databases were systematically searched for randomized controlled trials and observational studies. The main outcome was febrile neutropenia (FN) 26 and secondary outcomes were bloodstream infection (BSI), Clostridioides difficile infection (CDI) and all-cause mortality (ACM). A random-effects meta-analysis was conducted. We included 7 studies with 991 patients; 439 (44.3%) used fluoroquinolone prophylaxis, of whom 255 used levofloxacin and 184 used ciprofloxacin. The B-cell immunophenotype was the most frequent. Fluoroquinolone prophylaxis reduced the risk of FN (46.1% vs 64.9%; OR 0.44; 95% CI 0.33-0.59; I = 0%). Fluoroquinolone prophylaxis also significantly reduced the risk of BSI (OR 0.50; 95% CI 0.32-0.81; I = 0%). Risks of CDI (OR 0.43; 95% CI 0.00-42.30; I = 39.6%) and ACM (OR 1.04; 95% CI 0.20-5.38; I = 54.3%) were not significantly altered.
CONCLUSIONS: Fluoroquinolone prophylaxis during induction chemotherapy for pediatric ALL significantly reduces FN and BSI without increasing C. difficile risk. While overall mortality is unchanged, reducing infectious morbidity may enhance treatment tolerance.
WHAT IS KNOWN: • Febrile neutropenia and bloodstream infections are major causes of treatment-related morbidity and mortality during induction chemotherapy in pediatric acute lymphoblastic leukemia and fluoroquinolone prophylaxis has shown inconsistent results across studies. • Prior evidence suggests potential reduction in infectious complications, but is limited by heterogeneous populations and lack of analyses specific for induction phase.
WHAT IS NEW: • This systematic review and meta-analysis focused specifically on the induction phase of pediatric acute lymphoblastic leukemia and demonstrates that fluoroquinolone prophylaxis significantly reduces febrile neutropenia and bloodstream infections with consistent effect across study designs. • The study provides pooled estimate from an specific phase showing no clear increase in Clostridioides difficile infection, demonstrating the risk-benefit profile of fluoroquinolone prophylaxis.
Digital and AI-supported psychosocial interventions modestly reduce distress and improve quality of life in women with breast cancer
Digital mental health tools may help breast cancer patients feel better
Related in Oncology
Meta-analysis of surgical resection for lung neuroendocrine tumors
Sparing Lung Tissue May Save Lives Without Hurting Survival Rates
This meta-analysis of six studies compared lobectomy to sub-lobar resection for lung neuroendocrine tumors. It found no significant differen…
New research shows taking less lung tissue during surgery for rare tumors gives patients the same long-term survival chance as taking more.
Systematic review and meta-analysis compares intravesical gemcitabine/docetaxel versus BCG for non-muscle-invasive bladder cancer
Gemcitabine and docetaxel show similar recurrence-free survival to BCG for bladder cancer
This systematic review and meta-analysis evaluated intravesical gemcitabine and docetaxel compared with Bacillus Calmette-Guérin (BCG) in pa…
A meta-analysis of 1634 patients found gemcitabine and docetaxel offered recurrence-free survival rates comparable to BCG therapy for non-mu…
FDA Approves Enhertu (fam-trastuzumab deruxtecan-nxki) for Multiple HER2-Positive and HER2-Low Cancers
FDA approves Enhertu for several types of HER2 positive cancers.
FDA approved Enhertu for several indications including HER2-positive metastatic breast cancer, HER2-low and HER2-ultralow breast cancer, HER…
The FDA has approved Enhertu for multiple cancers, including breast, lung, stomach, and other solid tumors that have a specific protein call…
FDA Approves Revlimid (lenalidomide) for Multiple Myeloma and Other Indications
FDA approves Revlimid for several blood cancers and related conditions.
FDA approved Revlimid (lenalidomide) for multiple myeloma (in combination with dexamethasone and as maintenance after auto-HSCT), transfusio…
The FDA approved Revlimid (lenalidomide) for multiple myeloma, certain myelodysplastic syndromes, mantle cell lymphoma, and other lymphomas.…
From Other Specialties
Guideline on severe pediatric obesity with MC4R variant and puberty management
Two siblings with severe obesity and early puberty found to have genetic changes affecting their growth and health over fourteen years
This guideline, based on a case report of two Chinese siblings with a heterozygous MC4R variant, synthesizes long-term management of monogen…
Two Chinese brothers with severe obesity and early puberty received special treatments for fourteen years. Their puberty slowed down, blood …
Systematic review of post-stroke delirium prediction models finds moderate discriminative ability
New Tools Help Spot Confusion After a Stroke
This systematic review and meta-analysis synthesized 12 studies constructing 21 risk prediction models for post-stroke delirium. The combine…
Doctors can now spot dangerous confusion after a stroke more accurately using new prediction tools that look at age and heart health.
Meta-analysis shows association between adequate antimicrobial therapy and reduced hospital length of stay
Right Antibiotic Choice Cuts Hospital Stay by Nearly Two Weeks
This meta-analysis of 4158 adult hospitalised patients examines the relationship between adequate empirical antibiotic therapy and clinical …
Choosing the right antibiotic from the start can cut a hospital stay by nearly two weeks for adults with serious infections.
Meta-analysis evaluates high-intensity focused ultrasound for primary breast cancer treatment
Using ultrasound heat therapy to treat certain types of breast cancer
This meta-analysis examines the efficacy and safety of high-intensity focused ultrasound (HIFU) ablative therapy in patients with primary br…
A recent review shows how ultrasound heat therapy might help treat breast cancer without major surgery.