Decrease of Postchemotherapy Complications With the Use of Probiotics in Children With Acute Lymphoblastic Leukemia

Abstract

Introduction: During the administration of antineoplastic drugs, acute complications because of toxicity occur, determining their hospital readmission, visits to the emergency department, use of antimicrobials, and possibilities of presenting systemic infections, impacting on their life quality. Methods: Through a prospective cohort, 60 children with acute lymphoblastic leukemia were followed-up for 30 days after the hospital discharge because of chemotherapy administration, those patients were previously included in a single-blinded study in which 30 (group 1) received Lactobacillus rhamnosus GG probiotic during the administration of chemotherapy. The remaining 30 patients did not receive probiotics (group 2). There were evaluated gastrointestinal symptoms, such as diarrhea, dyspepsia, abdominal distension, meteorism, constipation, nausea, and vomit, development of infections, antibiotic use, number of emergency department visits, number of hospitalizations, and sepsis diagnosis. Statistical Analysis: To assess the impact of the use of probiotics, the difference in proportions between both study groups was evaluated. Results: Gastrointestinal manifestations (nausea, vomiting, diarrhea, constipation) occurred in 30% of patients in group 1 versus 63% of group 2 (P=0.009). Nine of 30 patients (30.0%) in group 1 went to the emergency room, versus 33.3% of group 2 (P=0.7). Antimicrobials were used in 8 subjects (26.6%) in group 1 versus 6 subjects (53.3%) in group 2 (P=0.03) suspected of an infectious disease. Four (13.3%) group 1 patients were hospitalized versus 30% of group 2 (P=0.1). Two subjects (6.6%) in group 1 had sepsis versus 7 (23.3%) in group 2 (P=0.07). Conclusions: The results indicate that the use of probiotics can be a great alternative in the improvement of gastrointestinal symptoms and the adverse effects associated with chemotherapy.

Gut microbiome in pediatric acute leukemia: from predisposition to cure

“…During hospitalization, gastrointestinal side effects were less frequent in the probiotic group, in particular diarrhea, nausea, vomiting and abdominal distension 49 . After a 30-day follow-up after hospital discharge, the probiotic group still presented fewer gastrointestinal manifestations, in addition to lower use of antibiotics 50 .…”

The effect of physical exercise and dairy probiotics (Lactobacillus casei) on gut microbiome in childhood cancer survivors

“…Moreover, both prebiotic and probiotic interventions reduce infection and morbidity risk in pediatric cancer patients [49]. The latest results indicate that the use of a healthy diet and probiotics can be a great alternative for the improvement of gastrointestinal symptoms and the adverse effects associated with cancer treatment [50,51].Here we report a significantly increased relative abundance of Lactobacillus casei. This outcome may have been apparent while L. casei was dominant in the dairy probiotic daily administered to children for 8 weeks.…”

Integrative Hematology: State of the Art

“…A small prospective study performed by Reyna-Figueroa et al in patients with ALL and AML aimed to use Lactobacillus Rhamnosus to mitigate the gastrointestinal side effects of chemotherapy. Indeed, patients experienced a reduction in nausea, vomiting and diarrhea (30% versus 63%) ( p = 0.009) and a reduction in the use of antimicrobial agents (26.6% versus 53.3) ( p = 0.03) [ 136 ]. Furthermore, since some complications such as acute GVHD seem to be mediated, in part, by the production of Lipopolysaccharide, the use of some probiotic strains such as Lactobacillus rhamnosus GG could improve its course.…”