Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Myeloma

Oral antibiotic prophylaxis of early infection in multiple myeloma: a URCC/ECOG randomized phase III study

Leukemia volume 26, pages 2517–2520 (2012)Cite this article

Subjects

Abstract

Multiple myeloma (MM) is a malignancy of clonal plasma cells, resulting in an increased production of ineffective immunoglobulins with suppression of non-involved immunoglobulins. Patients with MM are at increased risk of infectious complications, particularly streptococcal and staphylococcal infections. This study evaluated the impact of prophylactic antibiotics on the incidence of serious bacterial infections (SBIs) during the first 2 months of treatment in patients with newly diagnosed MM. Patients with MM receiving initial chemotherapy were randomized on a 1:1:1 basis to daily ciprofloxacin (C; 500 mg twice daily), trimethoprim-sulfamethoxazole (T; DS twice daily) or observation (O) and evaluated for SBI (Eastern Cooperative Oncology Group ⩾grade 3) for the first 2 months of treatment. From July 1998 to January 2008, 212 MM patients were randomized to C (n=69), T (n=76) or O (n=67). The incidence of SBI was comparable among groups: C=12.5%, T=6.8% and O=15.9%; P=0.218. Further, any infection during the first 2 months was also comparable (20% vs 23% vs 22%, respectively, P=0.954). We demonstrate that prophylactic antibiotics did not decrease the incidence of SBI (⩾grade 3) within the first 2 months of treatment. We conclude that routine use of prophylactic antibiotics should not be mandated for patients receiving induction chemotherapy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Augustson BM, Begum G, Dunn JA, Barth NJ, Davies F, Morgan G et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002–Medical Research Council Adult Leukaemia Working Party. J Clin Oncol 2005; 23: 9219–9226.

    Article  Google Scholar 

  2. Myers BR, Hirschman SZ, Axelrod JA . Current patterns of infection in multiple myeloma. Am J Med 1972; 52: 87–92.

    Article  Google Scholar 

  3. Savage DG, Lindenbaum J, Garret TJ . Biphasic pattern of bacterial infection in multiple myeloma. Ann Intern Med 1982; 96: 47–50.

    Article  CAS  Google Scholar 

  4. Jacobson DR, Zolla-Pazner PS . Immunosuppression and infection in multiple myeloma. Semin Oncol 1986; 13: 282–290.

    CAS  PubMed  Google Scholar 

  5. Doughney KB, Williams DM, Penn RL . Multiple myeloma: Infectious complications. South Med J 1988; 81: 855–888.

    Article  CAS  Google Scholar 

  6. Perri RT, Hebbel R, Oken MM . Influence of treatment and response status on infection risk in multiple myeloma. Am J Med 1981; 71: 935–940.

    Article  CAS  Google Scholar 

  7. Hargreaves RM, Lea JR, Griffiths H, Faux JA, Holt JM, Reid C et al. Immunological factors and risk of infection in plateau phase myeloma. J Clin Pathol 1995; 48: 260–266.

    Article  CAS  Google Scholar 

  8. Oken MM, Pomeroy C, Weisdorf D, Bennett JM . Prophylactic antibiotics for the prevention of early infection in multiple myeloma. Am J Med 1996; 100: 624–628.

    Article  CAS  Google Scholar 

  9. Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME et al. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol 2010; 11: 29–37.

    Article  CAS  Google Scholar 

  10. Gay F, Rajkumar SV, Coleman M, Kumar S, Mark T, Dispenzieri A et al. Clarithromycin (Biaxin)-lenalidomide-low-dose dexamethasone (BiRd) versus lenalidomide-low-dose dexamethasone (Rd) for newly diagnosed myeloma. Am J Hematol 2010; 85: 664–669.

    Article  CAS  Google Scholar 

  11. Chapel HM, Lee M, Hargreaves R, Pamphilon DH, Prentice AG . Randomised trial of intravenous immunoglobulin as prophylaxis against infection in plateau-phase multiple myeloma. The UK Group for Immunoglobulin Replacement Therapy in Multiple Myeloma. Lancet 1994; 343: 1059–1063.

    Article  CAS  Google Scholar 

  12. Salmon SE, Samal BA, Hayes DM, Hosley H, Miller SP, Schilling A . Role of gamma globulin for immunoprophylaxis in multiple myeloma. N Engl J Med 1967; 277: 1336–1340.

    Article  CAS  Google Scholar 

  13. Snowden JA, Ahmedzai SH, Ashcroft J, D’Sa S, Littlewood T, Low E et al. Guidelines for supportive care in multiple myeloma 2011. Br J Haematol 2011 154: 76–103.

    Article  CAS  Google Scholar 

  14. Chanan-Khan A, Sonneveld P, Schuster MW, Stadtmauer EA, Facon T, Harousseau JL et al. Analysis of herpes zoster events among bortezomib-treated patients in the phase III APEX study. J Clin Oncol 2008; 26: 4784–4790.

    Article  CAS  Google Scholar 

  15. Swaika A, Paulus A, Miller KC, Sher T, Almyroudis NG, Ball D et al. Acyclovir prophylaxis against Varicella zoster virus reactivation in multiple myeloma patients treated with bortezomib-based therapies: A retrospective analysis of 100 patients. J Support Oncol, ; e-pub ahead of print 4 January 2012.

Download references

Acknowledgements

We thank the members and staff of URCC and ECOG and the patients and their families. This work was supported in part by ECOG Grant numbers CA13650, CA21115 and CA23318.

Author information

Authors and Affiliations

  1. The John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA

    D H Vesole

  2. Northwestern Hospital, Minneapolis, MN, USA

    M M Oken

  3. University of Rochester, Rochester, NY, USA

    C Heckler & G R Morrow

  4. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    P R Greipp

  5. Eastern Cooperative Oncology Group, Boston, MA, USA

    M S Katz

  6. Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA

    S Jacobus

Authors
  1. D H Vesole
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M M Oken
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Heckler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P R Greipp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M S Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Jacobus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G R Morrow
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the University of Rochester Cancer Center and the Eastern Cooperative Oncology Group

Corresponding author

Correspondence to D H Vesole.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vesole, D., Oken, M., Heckler, C. et al. Oral antibiotic prophylaxis of early infection in multiple myeloma: a URCC/ECOG randomized phase III study. Leukemia 26, 2517–2520 (2012). https://doi.org/10.1038/leu.2012.124

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2012.124

Keywords

This article is cited by

Search

Advanced search

Quick links