The Incidence and Burden of Peripheral Neuropathy in Pediatric Oncology Patients Receiving Levofloxacin and Vincristine Compared With Vincristine Alone

Levofloxacin is the first line antibiotic used to prevent infection in pediatric oncology patients with prolonged and profound neutropenia. These patients often receive vincristine, a critical component of therapy for leukemia and for many solid tumors. Both levofloxacin and vincristine are known to cause peripheral neuropathy (PN); however, the cumulative effect of both drugs on PN remains unknown. The objective of this study was to evaluate the incidence and extent of PN in pediatric oncology patients receiving vincristine and levofloxacin (VL) compared with vincristine alone (VA). In this retrospective cohort study, manual chart review was performed to extract demographic and clinical data for newly diagnosed patients treated at our institution between 2015 and 2020. Patients who received vincristine alone (VA) were compared with patients who received vincristine and levofloxacin (VL). There was no significant difference in the incidence of peripheral neuropathy between the 2 groups; however, the cohort exposed to vincristine and levofloxacin (VL) experienced significantly more peripheral neuropathy symptoms, had more affected categories of peripheral neuropathy, and received additional treatment for their neuropathy symptoms. Exposure to levofloxacin in addition to vincristine therapy was associated with an increased burden of peripheral neuropathy in this pediatric oncology cohort.