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Azithromycin does not increase hematologic relapse in pediatric hematopoietic cell transplant recipients

Bone Marrow Transplantation volume 57, pages 1589–1591 (2022)Cite this article

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Azithromycin is a macrolide antibiotic with immunomodulatory effects that is used as an anti-inflammatory agent in multiple lung diseases [1, 2]. Fluticasone, azithromycin and montelukast combination therapy reduced steroid use and improved outcomes in hematopoietic cell transplant (HCT) recipients with bronchiolitis obliterans syndrome (BOS) [3,4,5,6]. These findings suggested azithromycin was a safe and likely effective treatment for BOS.

However, a study of azithromycin prophylaxis (started during conditioning) in adult HCT recipients was halted due to increased mortality and hematologic relapse in the azithromycin arm [7]. These findings were not observed in two subsequent studies of adults who received azithromycin for BOS treatment later in the transplant course [8, 9]. A third study reported an increased risk of hematologic relapse in patients who received azithromycin following matched unrelated donor (MUD) HCTs that used anti-thymocyte globulin (ATG) conditioning, but not in other HCTs [10]. No study has investigated the impact of early azithromycin exposure on hematologic relapse and mortality in pediatric HCT recipients.

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Acknowledgements

We would like to thank the patients and families at Cincinnati Children’s Hospital Medical Center for their research contributions and commitment to improving transplant outcomes.

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Authors and Affiliations

  1. Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Anthony Sabulski, Gregory Wallace, Adam Lane, Stella M. Davies & Kasiani C. Myers

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Anthony Sabulski, Adam Lane, Stella M. Davies & Kasiani C. Myers

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  1. Anthony Sabulski
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Contributions

AS wrote the manuscript, performed chart reviews, designed tables and performed statistical analyses. GW performed chart reviews and edited the manuscript. AL performed statistical analyses and reviewed the manuscript. SMD designed the study and edited the manuscript. KCM designed the study, oversaw the study and edited the manuscript.

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Correspondence to Anthony Sabulski.

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Competing interests

AS has consulted for SOBI. SMD has received research support from Alexion Pharmaceuticals and consultancies with Novartis, Rocket Pharma, CIRM, Allovir and Neurogene.

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Sabulski, A., Wallace, G., Lane, A. et al. Azithromycin does not increase hematologic relapse in pediatric hematopoietic cell transplant recipients. Bone Marrow Transplant 57, 1589–1591 (2022). https://doi.org/10.1038/s41409-022-01746-y

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