To reduce the frequency of infection in acute leukemia, we employed isolation and air-filtration facilities (“protected environment”) and a prophylactic regimen that included oral nonabsorbable antibiotics. Eighty-eight randomized patients received identical remission-induction chemotherapy within one of three groups: protected environment combined with the prophylactic regimen (Group 1); oral nonabsorbable antibiotics alone (Group 2); and neither isolation nor prophylaxis (Group 3). The groups were comparable in factors that might influence the course of leukemia and susceptibility to infection. Environmental maneuvers. were effective in reducing the potential inoculum of ambient micro-organisms. Patients in Group 1 had 1/2 as many severe infections as those in Groups 2 and 3. Whereas approximately 1/4 of the patients in Groups 2 and 3 died of infection while on study, none in Group 1 died for that reason. Despite fewer infections in Group 1, no intergroup differences were found in remission rate or duration. The ultimate benefits of reduced infectious morbidity in leukemia may depend on further advances in chemotherapy. INFECTIOUS complications comprise the leading cause of morbidity and mortality in patients with acute leukemia.1 Moreover, the presence or possibility of infection often represents an impediment to the completion of adequate trials of aggressive antileukemic therapy.2 The frequency of bacterial infection in leukemia has been shown to be directly related to the duration and degree of granulocytopenia, a consequence of both the disease and its therapy.3 Leukemic rodents germ free from birth tolerate greater dosages of radiation and antitumor chemotherapy than conventional animals since they do not become infected.4 5 6 7 A decrease in the bacterial load carried by leukemic patients may.
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