Efficacy and Safety of Linezolid in Immunocompromised Patients with Hematological Malignancy

The aim of this study was to determine the safety, tolerance and efficacy of linezolid for the treatment of infections from Gram-positive bacteria in immunocompromised patients with Hematological Malignancy.

This was a prospective non-comparative unblinded and multi-center study in the Hematology Unit over a one-year period, administering combined use of linezolid in patients with Hematological Malignancy.

Fifth-four adult patients received linezolid (600 mg, iv, q12h per day). Thirty-four children received linezolid (30 mg/kgr: 3 i.v. per day).Mean duration of linezolid administration was 12.8 days (range, 10–23days). Among the evaluable patients, fifty four were adults, the median age was 67(range, 30–101years); thirty four were children (range, 11 months-12.6 years), while the median age was 6 years. Primary diagnosis was acute lymphoblastic leukemia (forty-five patients), lymphoma (twenty-three patients), multiple myeloma (eleven patients), Aplastic anemia(four patients), myelodysplasia syndrome(one patients), leucopenia and hemophagocytic syndrome (two patient each). All patients were immunocompromised, 90% of them in the midst of chemotherapy cycles. The mean base number of platelet was 41×10⁹/L(range, 30 – 138×10⁹/L), platelet count less than 30×10⁹/L patients were 28 cases (33%), among them, less than 10×10⁹/L were 13 cases (14.8%). 27 out of 88 patients had positive blood cultures, methicillin-resistant Staphylococcus aureus, eighteen patients; Enterococcus, seven patients; Methicillin Resistant Staphylococcus Epidermidis and hemolytic streptococcus (one patient each).All patients were considered clinically cured after the end of the linezolid regimen (100% efficacy). The main adverse events were thrombocytopenia. There were 11 cases happened transient thrombocytopenia, Among them, four cases were happened within 4 days, seven cases happened four to seven days after received linezolid. Eliminate the possibility caused by reasons such as severe infection which can also result in thrombocytopenia, Linezolid related thrombocytopenia were only two cases (2.3%). Chemotherapy-induced myelotoxicity (90% patients) was not worsened during linezolid therapy. The platelet recovery time was also not lengthened during linezolid therapy. No bleeding episodes were presented, no Self-limited diarrhea were happened. The total adverse event rate was 2.3%; however, there was no premature cessation of linezolid in any patient.

Linezolid may be another effective and safe therapy to treat infections from resistant Gram-positive bacteria in immunocompromised patients, even in children.

No relevant conflicts of interest to declare.