Clinical experience of linezolid in bone marrow transplantation patients

Linezolid is an oxazolidinone antibiotic that has been associated with myelosuppression, including leukopenia and thrombocytopenia. Few studies have assessed the use of linezolid in bone marrow transplantation (BMT) patients. The authors evaluated patients who were admitted to the BMT service at their institution from 2001 to 2002 and had undergone ≥3 days of linezolid therapy. These patients (cases) were matched with BMT patients who had not undergone linezolid therapy (controls). Forty-nine patients were evaluated; 25 cases and 24 controls. The authors found no significant differences in the duration of neutropenia or thrombocytopenia, but there was a trend toward a difference in time to engraftment (P = .16). More bleeding episodes were seen and more platelet transfusions were needed in cases than in controls (16% vs 8%; P = .35 and 54.5 ± 55.0 units vs 19.9 ± 20.0 units, respectively). Patients who had undergone linezolid therapy for >10 days (n = 10) had longer thrombocytopenia (102.2 ± 98.0 vs 62.0 ± 61.0 days; P = .27) and time to engraftment (20.5 ± 20.0 vs 10.7 ± 2.0 days; P = .16) and required more platelet transfusions (83.6 ± 76.0 vs 35.1 ± 23.0 units). None of these observations reached statistical significance. The authors conclude that linezolid therapy can be used safely in BMT patients for up to 10 days. However, when therapy is needed for >10 days, monitoring of platelet counts, bleeding time, and time to engraftment are recommended.