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Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (AHSCT) patients, its impact on morbidity and mortality is uncertain. This study investigates the role of quinolone prophylaxis after AHSCT in recent years.

Methods

We conducted a retrospective review of 291 consecutive adult patients who underwent AHSCT for malignant disorders, between June 2013 and January 2015. Outcomes were compared between patients who received norfloxacin prophylaxis and those who did not. The endpoints were mortality during prophylaxis and at 100 days after transplant, frequency of ICU admissions, and incidence and type of bacteremia.

Results

Of 291 patients, 252 patients received norfloxacin prophylaxis and 39 patients did not. The mortality during prophylaxis and at 100 days as well as the median number of days of hospitalization following AHSCT did not differ between the two groups. No differences were noted in the frequency of ICU admission, incidence of septic shock, and duration of ICU stay. Patients who did not receive prophylaxis had a significantly higher rate of neutropenic fever (97%) than patients who received prophylaxis (77%) (p = 0.005). The patients with prophylaxis demonstrated a significantly higher rate of gram-positive bacteremia as compared to those without prophylaxis (p = 0.002). Frequency of Clostridium difficile infection was similar during and post-prophylaxis. More antibiotic use was noted among patients without prophylaxis [97%; median 9 (range, 5–24) days] compared to patients with prophylaxis [79%; median 7 (range, 3–36) days, p = 0.04].

Conclusion

Although fluoroquinolone prophylaxis reduced the incidence of neutropenic fever and antibiotic use in AHSCT, it did not alter mortality or morbidity.

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Authors and Affiliations

  1. Department of Hematology-Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA

    Dipenkumar Modi

  2. Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA

    Hyejeong Jang & Seongho Kim

  3. Department of Internal Medicine, 3990 John R, 5904 5Hudson, Detroit, MI, 48201, USA

    Malini Surapaneni

  4. Wayne State School of Medicine, 320 E Canfield Ave; Suite 315, Detroit, MI, 48201, USA

    Kamya Sankar

  5. Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA

    Abhinav Deol, Lois Ayash, Divaya Bhutani, Voravit Ratanatharathorn & Joseph P. Uberti

  6. Division of Hematology/Oncology, University of Virginia Cancer Center, West Complex, Rm 7191, 1300 Jefferson Park Avenue, Charlottesville, VA, USA

    Lawrence G. Lum

  7. Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, 4100 John R, WN10SC, Detroit, MI, 48201, USA

    Richard Manasa & Kendra Mellert

  8. Division of Infectious Diseases, Wayne State University, Detroit, MI, 48201, USA

    Pranatharthi Chandrasekar

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  1. Dipenkumar Modi
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  2. Hyejeong Jang
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  3. Seongho Kim
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  4. Malini Surapaneni
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  9. Lawrence G. Lum
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  14. Joseph P. Uberti
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Corresponding author

Correspondence to Dipenkumar Modi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Declaration

We presented our study data at American Society of Blood and Marrow Transplantation (ASBMT) annual meeting 2016. Only abstract of our study was published in Biology of Blood and Marrow Transplantation journal supplement issue in March 2016, and only abstract is available online (Google scholar).

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Modi, D., Jang, H., Kim, S. et al. Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients. Support Care Cancer 25, 2593–2601 (2017). https://doi.org/10.1007/s00520-017-3670-3

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