Cancer chemotherapy and pharmacologyJul 6, 2026

How antibiotics may also fight leukemia: ways they work and treatment possibilities

Longevity & Aging Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jul 7, 2026

Abstract

Antibiotic-induced cytopenia is associated with hematologic toxicity that may reveal vulnerabilities in leukemia treatment.

Hematologic toxicity from antibiotics includes immune-mediated cytopenias and direct bone marrow suppression.
Molecular evidence links mitochondrial processes and oxidative stress to both hematotoxicity and potential antileukemic effects.
Selected tetracyclines, macrolides, and oxazolidinones show the strongest preclinical evidence for antileukemic activity.
Evidence for other antibiotic classes, such as beta-lactams and fluoroquinolones, is limited or primarily hypothesis-generating.
Antibiotic-induced cytopenia should not be taken as definitive proof of leukemia selectivity due to various confounding factors.
Clinical development of these strategies requires validation of pharmacokinetics, normal hematopoietic comparators, and suitable biomarkers.

Simplified

Antibiotics are among the transformative advances in medicine, but many interact with mammalian cellular targets and pathways beyond their antimicrobial activity. A clinically important expression of these off-target effects is hematologic toxicity, including immune-mediated cytopenias and direct bone marrow suppression. This narrative review examines whether the same biology that injures normal hematopoietic cells can, in selected contexts, reveal therapeutically exploitable vulnerabilities in leukemia. We synthesize molecular, clinical, and preclinical evidence and organize it into an integrative framework linking mitochondrial translation inhibition, mitonuclear imbalance, oxidative phosphorylation failure, reactive oxygen species generation, DNA/topoisomerase stress, autophagy and lysosomal-flux blockade, and apoptosis modulation with both hematotoxicity and antileukemic activity. The strongest preclinical evidence supports selected tetracyclines, macrolides, and oxazolidinones, whereas evidence for beta-lactams, glycopeptides, polymyxins, rifamycins, fluoroquinolones, and folate-pathway agents remains more limited or largely hypothesis-generating. Importantly, antibiotic-induced cytopenia should not be interpreted as proof of leukemia selectivity: immune-mediated toxicity, supratherapeutic in vitro exposure, normal progenitor injury, pharmacokinetic constraints, microbiome effects, and resistance mechanisms all narrow the translational window. Overall, antibiotic hematotoxicity is best viewed as a biologically informative signal that can guide mechanism-based repurposing and combination strategies, but clinical development requires rigorous pharmacokinetic/pharmacodynamic validation, normal hematopoietic comparators, and biomarker-driven patient selection.

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Funding

Competing interests

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: Not applicable.

PubMed

How antibiotics may also fight leukemia: ways they work and treatment possibilities

Abstract

Full Text

Funding

Competing interests

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