Achilles heel.

Bacterial infection is a serious risk of mortality for patients with myeloma. Despite big advances in myeloma therapy, mortality from infection early in treatment remains a major concern. The TEAMM trial randomized nearly 1000 patients starting treatment for symptomatic myeloma to 12 weeks of prophylactic levofloxacin (500 mg once daily) versus placebo. Levofloxacin reduced the primary endpoint of first febrile episode or death from 27 → 19%. While an independent review of cause of death did not demonstrate a difference between groups, the levo arm importantly experienced no increase in adverse events. TBL: Prophylactic levofloxacin reduces the rate of febrile episodes (and/or death) in the first 12 weeks of starting therapy for myeloma. | Drayson, Lancet Oncol 2019