Fluoroquinolone prophylaxis does not increase risk of neuropathy in children with acute lymphoblastic leukemia

Cancer Med. 2020 Sep;9(18):6550-6555. doi: 10.1002/cam4.3249. Epub 2020 Jul 25.

Abstract

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.

Keywords: antibiotic; child; ciprofloxacin; leukemia; levofloxacin; lymphoid; polyneuropathy; prophylaxis.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Age Factors
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Antibiotic Prophylaxis* / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Child
  • Child, Preschool
  • Female
  • Fluoroquinolones / administration & dosage*
  • Fluoroquinolones / adverse effects
  • Humans
  • Induction Chemotherapy / adverse effects
  • Infant
  • Infant, Newborn
  • Male
  • Motor Neurons / drug effects
  • Neuralgia / chemically induced
  • Neuralgia / physiopathology
  • Neurotoxicity Syndromes / diagnosis
  • Neurotoxicity Syndromes / etiology*
  • Neurotoxicity Syndromes / physiopathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sensory Receptor Cells / drug effects
  • Time Factors
  • Treatment Outcome
  • Vincristine / administration & dosage
  • Vincristine / adverse effects*

Substances

  • Anti-Bacterial Agents
  • Fluoroquinolones
  • Vincristine