Salvage tigecycline in high risk febrile neutropenic patients with hematological malignancies: a prospective multicenter study

Abstract

The purpose of this prospective, multi-center study was to examine the efficacy and safety of tigecycline as empirical treatment in neutropenic patients with hematological malignancies who failed to respond to first-line antibiotics. A total of 125 patients with persistent fever (>72 h) despite first-line antibiotics received empirical treatment with tigecycline (loading dose of 100 mg, followed by 50 mg every 12 h). The use of other antimicrobial agents was not restricted. Treatment success rate was 68.0%. Subgroup analysis revealed a success rate of 73.1% in patients with pneumonia and 35.3% in patients with bacteremia. Toxicities were moderate with gastrointestinal symptoms being the main side effects. In conclusion, tigecycline-based antibacterial regimen was a justifiable empirical treatment in febrile neutropenic patients who failed to respond to first-line antibiotics except those with bacteremia. For patients with bacteremia, trials on higher-dose of tigecycline are needed.

Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis

“…Due to the usage of the standard antibiotic regimen in each patient, our patient cohort is more homogeneous, facilitating the interpretation of results. Compared to the high response rate of 68% observed by Zhou et al [ 26 ], our response rate was much lower, but as in the study by Schwab et al [ 25 ], concomitant or previous antibiotic therapy was not standardized in the study by Zhou and colleagues, thereby implying that other antibiotics of last resort could have been applied in addition to tigecycline. Furthermore, there was no control group in this prospective study to compare the overall response and outcome.…”

“…The authors could show that patients in prolonged neutropenia—who are a comparable cohort to our patients—had a lower response rate of only 13% to tigecycline-based regimens, which is significantly worse than in our cohort [ 25 ]. In a prospective study conducted by Zhou et al in 2018, tigecycline was administered to 125 patients with hematological malignancies and neutropenic fever after 72 h of treatment with first-line antibiotics [ 26 ]. The authors could observe a high response rate of 68% in this patient cohort [ 26 ].…”

“…In a prospective study conducted by Zhou et al in 2018, tigecycline was administered to 125 patients with hematological malignancies and neutropenic fever after 72 h of treatment with first-line antibiotics [ 26 ]. The authors could observe a high response rate of 68% in this patient cohort [ 26 ].…”

Tigecycline as salvage treatment of febrile neutropenia in patients with haematological malignancies—a retrospective single-centre analysis of 200 cases

“…Interestingly 34 patients received tigecycline after failure of piperacillin/tazobactam monotherapy with a response rate of 69% in bacteraemia and 86% in FUO [ 22 ]. In another prospective study, 68% of 125 patients with febrile neutropenia responded to tigecycline as second-line therapy [ 14 ]. The response rates of most of these studies were similar and our study had comparable response rates to tigecycline of 73.6% overall and 69.4% in neutropenic patients.…”

“…Some studies have also demonstrated efficacy for cancer patients. In two retrospective and one prospective analysis, tigecycline was effective in the treatment of febrile neutropenia in second-and thirdline therapy [12][13][14].…”