Vancomycin Taper-and-Pulse Therapy for Recurrent Clostridioides difficile Infection in Pediatric Acute Lymphoblastic Leukemia Patients Treated With Blinatumomab and Chemotherapy: A Report of Three Cases.

This study enrolled three pediatric patients with B-cell acute lymphoblastic leukemia (B-ALL) who had recurrent Clostridioides difficile infection (rCDI) and were receiving blinatumomab in combination with chemotherapy. Each patient harbored multiple simultaneous risk factors for rCDI, including broad-spectrum antibiotic exposure and immunosuppression. All patients were treated with a vancomycin taper-and-pulse regimen and achieved clinical resolution without documented CDI recurrence over three to eight months of follow-up, without prolonged interruption of anti-leukemic therapy. These cases suggest that vancomycin taper-pulse may offer a practical treatment option for rCDI in this high-risk, vulnerable population, particularly in resource-limited settings.