Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
Background Fluoroquinolone antibiotics are frequently utilized in pediatric oncology patients as prophylaxis or step‐down therapy following broad spectrum beta‐lactam therapy for febrile neutropenia. Concerns regarding neurotoxicity limit the use of these agents. No studies have evaluated the associ...
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Veröffentlicht in: | Cancer medicine (Malden, MA) MA), 2020-09, Vol.9 (18), p.6550-6555 |
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Sprache: | eng |
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Zusammenfassung: | Background
Fluoroquinolone antibiotics are frequently utilized in pediatric oncology patients as prophylaxis or step‐down therapy following broad spectrum beta‐lactam therapy for febrile neutropenia. Concerns regarding neurotoxicity limit the use of these agents. No studies have evaluated the association between fluoroquinolone use and neurotoxicity in pediatric oncology patients receiving other neurotoxic agents such as vincristine.
Methods
An observational cohort study comprising patients aged 0‐18 at diagnosis enrolled on a prospective study for treatment of acute lymphoblastic leukemia (ALL) at a pediatric comprehensive cancer center between October 2007 and November 2018. Data for neuropathic pain and sensory or motor neuropathy were collected prospectively, and a Cox proportional hazards regression model was used to evaluate associations between administration of fluoroquinolone antibiotics during induction therapy and subsequent development of vincristine‐induced peripheral neurotoxicity (VIPN).
Results
A total of 598 participants were enrolled, including 338 (57%) who received fluoroquinolones during induction therapy; of these 470 (79%) were diagnosed with VIPN and 139 (23%) were diagnosed with high‐grade (Grade 3+) VIPN. On unadjusted analyses, and analyses adjusted for age and race, there was no evidence of an association between fluoroquinolone exposure and subsequent VIPN (hazard ratio [HR] 0.8, 95% CI 0.5‐1.04, P = .08) or high‐grade VIPN (HR 1.1, 95% CI 0.4‐2.2, P = .87).
Conclusions
The results of this observational study do not show an association between exposure to fluoroquinolone antibiotics during induction therapy for ALL and subsequent development of vincristine‐induced peripheral neuropathies, and suggest that a large increase in VIPN is unlikely.
Both vincristine and fluoroquinolone antibiotics can cause peripheral neurotoxicity, but it is not known whether coadministration of fluoroquinolones increases the risk of vincristine‐induced peripheral neurotoxicity (VIPN). In this cohort study of 598 pediatric patients undergoing treatment for acute lymphoblastic leukemia, VIPN was common, but fluoroquinolone prophylaxis during induction therapy did not increase the risk. |
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ISSN: | 2045-7634 2045-7634 |
DOI: | 10.1002/cam4.3249 |