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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 assoc...

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Autores principales: Karol, Seth E., Sun, Yilun, Tang, Li, Pui, Ching‐Hon, Ferrolino, Jose, Allison, Kim J., Cross, Shane J., Evans, William E., Crews, Kristine R., Jeha, Sima, Wolf, Joshua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520302/
https://www.ncbi.nlm.nih.gov/pubmed/32710497
http://dx.doi.org/10.1002/cam4.3249
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author Karol, Seth E.
Sun, Yilun
Tang, Li
Pui, Ching‐Hon
Ferrolino, Jose
Allison, Kim J.
Cross, Shane J.
Evans, William E.
Crews, Kristine R.
Jeha, Sima
Wolf, Joshua
author_facet Karol, Seth E.
Sun, Yilun
Tang, Li
Pui, Ching‐Hon
Ferrolino, Jose
Allison, Kim J.
Cross, Shane J.
Evans, William E.
Crews, Kristine R.
Jeha, Sima
Wolf, Joshua
author_sort Karol, Seth E.
collection PubMed
description 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.
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spelling pubmed-75203022020-09-30 Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia Karol, Seth E. Sun, Yilun Tang, Li Pui, Ching‐Hon Ferrolino, Jose Allison, Kim J. Cross, Shane J. Evans, William E. Crews, Kristine R. Jeha, Sima Wolf, Joshua Cancer Med Clinical Cancer Research 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. John Wiley and Sons Inc. 2020-07-25 /pmc/articles/PMC7520302/ /pubmed/32710497 http://dx.doi.org/10.1002/cam4.3249 Text en © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Cancer Research
Karol, Seth E.
Sun, Yilun
Tang, Li
Pui, Ching‐Hon
Ferrolino, Jose
Allison, Kim J.
Cross, Shane J.
Evans, William E.
Crews, Kristine R.
Jeha, Sima
Wolf, Joshua
Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
title Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
title_full Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
title_fullStr Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
title_full_unstemmed Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
title_short Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
title_sort fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia
topic Clinical Cancer Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520302/
https://www.ncbi.nlm.nih.gov/pubmed/32710497
http://dx.doi.org/10.1002/cam4.3249
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