Impact of doxycycline on mycoplasma pneumonia treatment and cancer prognosis in pediatric leukemia patients post-chemotherapy: a target trial emulation
Abstract
BACKGROUND
Acute leukemia is the most common malignancy in children. While chemotherapy is effective, it significantly compromises immune function, leading to a high incidence of infectious complications, such as secondary pneumonia, particularly Mycoplasma pneumonia (MP). The treatment of infections in pediatric leukemia patients faces challenges such as antibiotic resistance and drug interactions during chemotherapy.
OBJECTIVE
This study aims to evaluate the therapeutic efficacy and safety of doxycycline in treating MP in pediatric leukemia patients post-chemotherapy, as well as it impact on chemotherapy continuity.
METHODS
This study employed a target trial emulation design using retrospective data from pediatric leukemia patients diagnosed with MP. Patients aged 12-17 years with confirmed leukemia and clinical evidence of pneumonia following chemotherapy were included. Doxycycline was compared to azithromycin and other empirical treatments. Follow-up assessments at 3 days, 5 days, 30 days, and 180 days evaluated fever resolution, radiological improvement, additional interventions, and adverse events. Statistical analyses included Kaplan-Meier survival analysis and Cox proportional hazards models.
RESULTS
In Trial 2, doxycycline demonstrated a significantly higher treatment success rate than other empirical treatments (87.72% vs. 73.13%, P = 0.013) and was associated with faster fever resolution (P = 0.048) and shorter time to chest X-ray improvement (P = 0.048). The…
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