Blood Res.  2022 Mar;57(1):51-58. 10.5045/br.2021.2021176.

Real-world evidence of levofloxacin prophylaxis in elderly patients with newly diagnosed multiple myeloma who received bortezomib, melphalan, and prednisone regimen

• Kim SI
• Jung SH
• Yhim HY
• Jo JC
• Song GY
• Kim M
• Ahn SY
• Ahn JS
• Yang DH
• Kim HJ
• Lee JJ

• KMID: 2527497
• DOI: http://doi.org/10.5045/br.2021.2021176

Abstract

Background
Although survival outcomes of multiple myeloma (MM) have improved with the development of new and effective agents, infection remains the major cause of morbidity and mortality. Here, we evaluated the efficacy of levofloxacin prophylaxis (in a real-world setting) during bortezomib, melphalan, and prednisone (VMP) therapy in elderly patients with newly diagnosed MM.
Methods
This study retrospectively analyzed the records of patients with newly diagnosed MM treated with the VMP regimen between February 2011 and September 2020 at three institutes of the Republic of Korea.
Results
Of a total of 258 patients, 204 (79.1%) received levofloxacin prophylaxis during VMP therapy. The median number of levofloxacin prophylaxis cycles was 4 (range, 1‒9), but 10 patients did not complete the planned prophylaxis because of side effects. Sixty-six patients (25.5%) experienced severe infections during VMP therapy, most of which (74.7%) occurred within the first four cycles of VMP therapy regardless of levofloxacin prophylaxis status. Early severe infection was significantly associated with poor survival. In multivariate analysis, levofloxacin prophylaxis was significantly associated with a lower risk in early severe infection.
Conclusion
Our findings suggest that levofloxacin prophylaxis should be considered at least during the first four cycles of VMP therapy in elderly patients with newly diagnosed MM.

Keyword

Early infection; Prophylaxis; Levofloxacin; Multiple myeloma

Figure

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  Fig. 1 Rates of severe infection by levofloxacin prophylaxis status of patients during bortezomib, melphalan, and prednisone (VMP) therapy.

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  Fig. 2 Kaplan-Meier curves for progression-free survival (PFS) and overall survival (OS) in all patients (A, B) and those who experienced early severe infections (C, D).

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