Children with childhood leukemia benefit from prophylactic antibiotics

December 06, 2015

ORLANDO, FL (Dec. 6, 2015) - Prophylactic antibiotics significantly reduce the risk of serious bacterial infections in children during the critical first month of treatment for acute lymphoblastic leukemia (ALL), the most common childhood cancer, according to a U.S. and Canadian study led by investigators from Dana-Farber/Boston Children's Cancer and Blood Disorders Center. While the overall cure rate for ALL is high, about one to two percent of children with this diagnosis die during the first month of therapy from treatment complications, primarily infection-related.

The investigators, reporting their findings at the 57th annual meeting of the American Society of Hematology (abstract #249), found that prophylactic antibiotic treatment reduced the incidence of infection by approximately 60 percent compared to historic controls.

Both ALL and the chemotherapy used to treat it impact patients' immune systems, leaving them vulnerable to infection by a variety of bacteria. The risk of infection is particularly high during the first or "induction" phase of ALL treatment, when oncologists attempt to push the leukemia into remission.

"Children who develop bacterial infections during induction can become severely ill and often need to be admitted to the intensive care unit," said 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 (DFCI) ALL Consortium clinical trials group. "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."

To determine whether preventive antibiotic treatment could reduce the rate of bacterial infections during induction therapy, the DFCI ALL Consortium added universal antibiotic prophylaxis to its 11-001 treatment protocol for pediatric ALL. Clinicians at nine sites participating in the consortium enrolled 229 newly diagnosed children with ALL on the protocol between 2012 and 2015. All of the patients received antibiotics through the entirety of their induction phase of treatment, whether or not they developed a fever. The research team compared the infection rate seen on protocol 11-001 with that of patients treated under the consortium's previous 05-001 ALL treatment protocol, which called for antibiotics to be administered only in response to fever and did not specify the duration of antibiotic treatment.

The study's data indicate that the prophylactic strategy did indeed reduce infection risk. The proportion of patients given prophylactic antibiotics who experienced at least one infection during induction-phase therapy on protocol 11-001 was 13.1 percent, approximately 50 percent lower than the proportion among patients treated on protocol 05-001 (26.6 percent). The incidence of bacterial infection among children on protocol 11-001 was 9.9 percent, approximately 60 percent lower than that among children on protocol 05-001 (24.7 percent).

The study team noted no significant differences in the rates of other treatment-related mortality, fungal infection or Clostridum difficile infection between the two protocols.

"While larger, randomized clinical trials are needed to confirm these findings, these are very exciting results," said Silverman. "The use of antibacterial prophylaxis appears to have made a profound difference for our patients."
-end-
About Dana-Farber/Boston Children's Cancer and Blood Disorders Center

The Dana-Farber/Boston Children's Cancer and Blood Disorders Center -- the nation's #1 pediatric cancer program, according to US News & World Report 2015-16 -- brings together two internationally known research and teaching institutions that have provided comprehensive care for pediatric oncology and hematology patients since 1947. The Harvard Medical School affiliates share a clinical staff that delivers inpatient care and surgery at Boston Children's Hospital, outpatient oncology care at Dana-Farber Cancer Institute and outpatient blood disorders care at Boston Children's.

Dana-Farber Cancer Institute

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.