Acute Myeloid Leukemia Clinical Trial
Levofloxacin in Preventing Infection in Young Patients With Acute Leukemia Receiving Chemotherapy or Undergoing Stem Cell Transplantation
Summary
This randomized phase III trial studies how well levofloxacin works in preventing infection in young patients with acute leukemia receiving chemotherapy or undergoing stem cell transplant. Giving antibiotics may be effective in preventing or controlling early infection in patients receiving chemotherapy or undergoing stem cell transplant for acute leukemia. It is not yet known whether levofloxacin is effective in preventing infection.
Full Description
PRIMARY OBJECTIVES:
I. To determine whether levofloxacin given prophylactically during periods of neutropenia to patients being treated with chemotherapy for acute leukemia (AL) or undergoing hematopoietic stem cell transplantation (HSCT) will decrease the incidence of bacteremia.
SECONDARY OBJECTIVES:
I. To determine the effect of prophylactic levofloxacin on resistance patterns of bacterial isolates from all sterile site cultures, and the evolution of antimicrobial resistance from peri-rectal swab isolates of Enterobacteriaceae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Streptococcus mitis.
II. To determine the effect of levofloxacin prophylaxis on total number of days of antibiotic administration (prophylactic, empiric, and treatment) in children undergoing therapy for AL or HSCT.
III. To determine whether levofloxacin prophylaxis reduces the incidence of fever with neutropenia, severe infection, and death from bacterial infection.
IV. To assess the safety of levofloxacin prophylaxis, with specific attention to musculoskeletal disorders including tendinopathy and tendon rupture.
V. To assess the impact of prophylactic levofloxacin on the incidence of Clostridium difficile-associated diarrhea (CDAD), and the incidence of microbiologically documented invasive fungal infections (IFI).
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive levofloxacin orally (PO) or intravenously (IV) over 60-90 minutes once daily (QD) or twice daily (BID) beginning on day 3 during 2 consecutive courses of chemotherapy or beginning on day -2 during HSCT and continuing until blood counts recover.
ARM II: Patients receive established standard of care and receive chemotherapy or HSCT as patients in Arm I.
After completion of study therapy, patients are followed up for 1 year.
Eligibility Criteria
Inclusion Criteria:
Patient must fit 1 of the following 2 categories:
Chemotherapy patients
Planned to receive at least 2 consecutive cycles (not required to be the first 2 cycles) of intensive chemotherapy for either:
De novo, relapsed or secondary acute myeloid leukemia (AML), or acute leukemia of ambiguous lineage treated with standard AML therapy
Relapsed acute lymphoblastic leukemia (ALL)
For the purposes of this study, "intensive chemotherapy" is defined as regimens that are predicted by the local investigator to cause neutropenia for > 7 days; examples include, but are not limited to, treatment with "4-drug induction" (anthracycline, vincristine, asparaginase, and steroid), high dose cytarabine, anthracycline/cytarabine, ifosfamide/etoposide, and clofarabine-containing regimens
Stem cell transplantation patients
Planned to receive at least 1 myeloablative autologous or allogeneic HSCT
For the purposes of this study, myeloablative autologous and allogeneic HSCT are those in which the conditioning regimen is predicted by the local Investigator to cause neutropenia for > 7 days
Creatinine clearance or radioisotope glomerular filtration rate (GFR) > 70 mL/min/1.73 m^2 OR serum creatinine based on age/gender as follows:
0.5 mg/dL (6 months to < 1 year of age)
0.6 mg/dL (1 to < 2 years of age)
0.8 mg/dL (2 to < 6 years of age)
1.0 mg/dL (6 to < 10 years of age)
1.2 mg/dL (10 to < 13 years of age)
1.5 mg/dL (male)/1.4 mg/dL (female) (13 to < 16 years of age)
1.7 mg/dL (male)/1.4 mg/dL (female) (>= 16 years of age)
Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
All patients and/or their parents or legal guardians must sign a written informed consent
All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
Exclusion Criteria:
Patients previously enrolled on the trial are not eligible; therefore, patients with AL who were on study during intensive chemotherapy are not eligible to be enrolled during the HSCT
Patients with an allergy to quinolones
Patients with chronic active arthritis
Patients with a known pathologic prolongation of the corrected QT (QTc)
Females who are pregnant or breast feeding
Patients being treated with antibacterial agents, other than any of the following:
Cotrimoxazole or other agents including dapsone, atovaquone, and pentamidine administered for Pneumocystitis jiroveci (PCP) prophylaxis
Topical antibiotics
Central venous catheter antibiotic lock therapy
Note: prophylactic antifungal therapy is NOT an exclusion criterion
Patients currently enrolled on the ACCL1034 study are not eligible until they have completed the 90 day observation period of that study
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There are 83 Locations for this study
Little Rock Arkansas, 72202, United States
Downey California, 90242, United States
Duarte California, 91010, United States
Loma Linda California, 92354, United States
Long Beach California, 90806, United States
Los Angeles California, 90027, United States
Los Angeles California, 90048, United States
San Diego California, 92123, United States
San Francisco California, 94143, United States
Hartford Connecticut, 06106, United States
Wilmington Delaware, 19803, United States
Washington District of Columbia, 20010, United States
Washington District of Columbia, 20057, United States
Fort Myers Florida, 33908, United States
Jacksonville Florida, 32207, United States
Orlando Florida, 32827, United States
Pensacola Florida, 32504, United States
Saint Petersburg Florida, 33701, United States
West Palm Beach Florida, 33407, United States
Atlanta Georgia, 30322, United States
Augusta Georgia, 30912, United States
Chicago Illinois, 60612, United States
Oak Lawn Illinois, 60453, United States
Indianapolis Indiana, 46202, United States
Indianapolis Indiana, 46260, United States
Des Moines Iowa, 50309, United States
Lexington Kentucky, 40536, United States
Louisville Kentucky, 40202, United States
New Orleans Louisiana, 70112, United States
New Orleans Louisiana, 70118, United States
New Orleans Louisiana, 70121, United States
Baltimore Maryland, 21215, United States
Boston Massachusetts, 02111, United States
Boston Massachusetts, 02115, United States
Ann Arbor Michigan, 48109, United States
Grand Rapids Michigan, 49503, United States
Lansing Michigan, 48910, United States
Minneapolis Minnesota, 55404, United States
Jackson Mississippi, 39216, United States
Saint Louis Missouri, 63141, United States
Omaha Nebraska, 68114, United States
Omaha Nebraska, 68198, United States
Las Vegas Nevada, 89106, United States
Hackensack New Jersey, 07601, United States
New Brunswick New Jersey, 08901, United States
New Brunswick New Jersey, 08903, United States
Albuquerque New Mexico, 87106, United States
Bronx New York, 10467, United States
Buffalo New York, 14263, United States
New York New York, 10016, United States
New York New York, 10032, United States
Rochester New York, 14642, United States
Valhalla New York, 10595, United States
Asheville North Carolina, 28801, United States
Winston-Salem North Carolina, 27157, United States
Akron Ohio, 44308, United States
Cleveland Ohio, 44195, United States
Columbus Ohio, 43205, United States
Dayton Ohio, 45404, United States
Toledo Ohio, 43606, United States
Oklahoma City Oklahoma, 73104, United States
Bethlehem Pennsylvania, 18017, United States
Danville Pennsylvania, 17822, United States
Philadelphia Pennsylvania, 19104, United States
Pittsburgh Pennsylvania, 15224, United States
Columbia South Carolina, 29203, United States
Sioux Falls South Dakota, 57117, United States
Corpus Christi Texas, 78411, United States
Dallas Texas, 75390, United States
Fort Sam Houston Texas, 78234, United States
Fort Worth Texas, 76104, United States
Houston Texas, 77030, United States
San Antonio Texas, 78229, United States
San Antonio Texas, 78229, United States
Norfolk Virginia, 23507, United States
Spokane Washington, 99204, United States
Tacoma Washington, 98431, United States
Marshfield Wisconsin, 54449, United States
Winnipeg Manitoba, R3E 0, Canada
Saint John's Newfoundland and Labrador, A1B 3, Canada
Hamilton Ontario, L8N 3, Canada
Kingston Ontario, K7L 5, Canada
Toronto Ontario, M5G 1, Canada
Montreal Quebec, H3H 1, Canada
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