Despite a high overall cure rate for acute lymphoblastic leukemia, the most common childhood cancer, 1 to 2 percent of children die from primarily infection-related complications in the first month of treatment. New research from the Boston-based Dana-Farber Cancer Institute has shown that use of prophylactic antibiotics in this phase of treatment can reduce the instance of such infections by about 60 percent.
Both the chemotherapy and ALL itself weaken patients' immune system, leaving them more vulnerable to infections, particularly early in treatment. In order to determine the impact of using antibiotics to combat ALL infection rates, physicians across nine participating sites within the Dana-Farber Cancer Institute ALL Consortium added universal antibiotic prophylaxis to their treatment protocol for 229 newly diagnosed children.
The proportion of members of the universal antibiotic prophylaxis group who experienced at least one infection during early-phase therapy was 13.1 percent, about 50 percent lower than the patients who did not receive the antibiotic. The incidence of bacterial infection among the group with the prophylaxis protocol was about 60 percent lower than the children not receiving the antibiotic.
"Children who develop bacterial infections during induction can become severely ill and often need to be admitted to the intensive care unit," study senior investigator Lewis B. Silverman, MD, clinical director of the Hematologic Malignancies Center at Dana-Farber/Boston Children's and principal investigator of the Dana-Farber Cancer Institute ALL Consortium clinical trials group, said in a statement. "As a group, we realized that there was great variability among our institutions in terms of the management of leukemia patients who develop a fever. This study was designed to ask whether uniform guidelines for antibiotic prophylaxis and fever management could prevent infection-related morbidity and mortality in our patients. It was not clear, prior to starting the study, whether such a strategy would succeed, or whether the use of prophylaxis might increase the incidence of antibiotic-resistant infections or the frequency of fungal infections."