Can Antibiotics Prevent Infection in Patients With Newly Diagnosed Myeloma?
Posted: Monday, February 3, 2020
According to the findings of the phase III TEAMM trial, published in The Lancet Oncology, levofloxacin prophylaxis in patients with newly diagnosed myeloma during the first 12 weeks of therapy may “significantly reduce” febrile episodes and deaths. Professor Mark T. Drayson, FRCPath, of the University of Birmingham, United Kingdom, and colleagues found that the benefits of this preventive strategy, compared with placebo, remained significant even after adjusting for baseline prognostic factors.
“These results suggest that prophylactic levofloxacin could be used for patients with newly diagnosed myeloma undergoing antimyeloma therapy,” the authors concluded.
In this randomized, phase III trial, the investigators enrolled 977 patients with myeloma from 93 hospitals in the United Kingdom. All the patients involved had started active myeloma treatment within 14 days of enrollment. Of the enrolled, 489 patients received 500 mg of levofloxacin and 488 received a placebo.
After a median follow-up of 12 months, first febrile episodes or deaths occurred in 95 patients (19%) treated with levofloxacin and in 134 patients (27%) treated with placebo. In total, 597 serious adverse events were reported among the entire population within 16 weeks from the start of treatment (308 in the levofloxacin group and 289 in the placebo group). The events were similar between the two cohorts, except for five episodes of mostly reversible tendonitis in those treated with levofloxacin.
In closing, the investigators did acknowledge that the potential benefit of this antibiotic prophylactic strategy would have to be balanced with the chance of local antibiotic resistance. “Prolonged antibiotic prophylaxis after 12 weeks and combined antibiotic use for prophylaxis requires investigation in future studies,” they concluded.
Disclosure: For full disclosures of the study authors, visit thelancet.com.