Pneumocystis jirovecii pneumonia prophylaxis in allogeneic hematopoietic cell transplant recipients: can we always follow the guidelines?
| Autor: | Florence Beckerich, Roberta Di Blasi, Catherine Cordonnier, Ludovic Cabanne, Sébastien Maury, Rabah Redjoul, Mathieu Leclerc, F. Foulet, Françoise Botterel, Andrea Toma, Christine Robin, Cécile Pautas |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Side effect medicine.medical_treatment Hematopoietic stem cell transplantation urologic and male genital diseases Pneumocystis carinii Trimethoprim 03 medical and health sciences 0302 clinical medicine Internal medicine Sulfadoxine medicine Humans Adverse effect Atovaquone Pentamidine Aged Transplantation business.industry Pneumonia Pneumocystis Hematopoietic Stem Cell Transplantation Hematology Middle Aged bacterial infections and mycoses Allografts female genital diseases and pregnancy complications Regimen Drug Combinations 030220 oncology & carcinogenesis Chemoprophylaxis Female Guideline Adherence business 030215 immunology medicine.drug Follow-Up Studies |
| Zdroj: | Bone marrow transplantation. 54(7) |
| ISSN: | 1476-5365 |
| Popis: | Pneumocystis jirovecii pneumonia (PCP) is a life-threatening disease in allogeneic hematopoietic cell transplantation (HCT) recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred prophylaxis but has significant toxicity. We assessed 139 consecutive HCT patients for PCP prophylaxis in our center. According to our procedures, TMP-SMX should be given as first-line prophylaxis from engraftment. In case of intolerance, atovaquone (ATO) or aerosolized pentamidine may be given. Thirteen (9.3%) patients did not receive prophylaxis because they early died. Of the 126 prophylaxed patients, 113 (90%) received TMP-SMX and 13 (10%) received ATO as first-line regimen. However, only 51/113 (45%) patients received TMP-SMX as the sole prophylaxis: 60 patients were switched to ATO because of side effect. There were 18 PCP cases: 3 occurred before engraftment, 7 occurred under ATO, 3 occurred while prophylaxis was pending the resolution of side effects, and 5 occurred after stopping prophylaxis. No cases occurred under TMP-SMX while 7 (9.6%) cases occurred under first-(n = 13) or second (n = 60)-line ATO. There are many concerns about PCP prophylaxis after HCT: patients may develop PCP before engraftment or several months after stopping immunosuppressors, and half of them do not receive TMP-SMX all along the at-risk periods. New prophylactic drugs and strategies should be evaluated. |
| Databáze: | OpenAIRE |
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