Aerosolized pentamidine prophylaxis for <i>Pneumocystis carinii</i> pneumonia after allogeneic marrow transplantation

Marras, T.K.; Sanders, Kevin; Lipton, Jeffrey H.; Messner, Hans A.; Conly, John; Chan, Charles K.

doi:10.1034/j.1399-3062.2002.t01-1-00008.x

Cited by 59 publications

(37 citation statements)

References 24 publications

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“…11,22 Aerosolized pentamidine, atovaquone, or disulone are acceptable alternatives in case of intolerance but are probably less effective. [23][24][25][26] It should also be remembered that bone marrow toxicity is rare with the low doses of trimethoprim-sulfamethoxazole or sulfadoxinepyrimethamine used in prophylaxis, even in bone marrow recipients. 22,27 Following this study, we spread these recommendations among our team and only one case of PCP was observed during the following 2 years, as compared to 2-3 cases per year previously.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study

Castro

Neuville

Sarfati

et al. 2005

Bone Marrow Transplant

123

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Summary:Pneumocystis jiroveci pneumonia (PCP) has become a rare opportunistic infection due to the efficacy of prophylactic regimens. We conducted a 6-year retrospective study at our institution. A total of 13 cases of PCP were diagnosed among 519 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (2.5%). In three patients, PCP occurred within the first 5 months following HSCT. These severely immunocompromised patients were receiving prophylaxis and had concomitant aspergillosis that caused rapid death in two of them. In 10 other patients, PCP occurred a median of 14.5 months after HSCT. In all these patients, PCP prophylaxis had been discontinued, mainly because of the suspected bone-marrow toxicity of the prophylactic regimen. Median CD4 þ T cell count was 131/ll at diagnosis. Seven of these 10 patients were receiving immunosuppressive therapy for chronic graft versus host disease and three had a relapse of their hematological malignancy. One patient died from PCP despite high doses of cotrimoxazole. We conclude that PCP is still occurring after allogeneic HSCT, mainly as a late complication in patients in whom PCP prophylaxis had been prematurely discontinued. Long-term PCP prophylaxis should be maintained in patients receiving immunosuppressive drugs, and in those with low CD4 þ T cell counts or a relapse of their hematological malignancy. Pneumocystis jiroveci is an atypical fungus causing severe pneumonia in immunocompromised patients, particularly among allogeneic hematopoietic stem cell transplant (HSCT) recipients. 1 Before the use of prophylaxis, 5-16% of patients who received allogeneic marrow transplants developed P. jiroveci pneumonia (PCP) with a median onset at 9 weeks post-transplantation and a mortality rate of up to 76%. 2,3 Since the use of effective prophylaxis with trimethoprim-sulfamethoxazole, less than 5% of HSCT recipients still develop PCP. 2,4,5 However, recent studies have reported the occurrence of late onset PCP in patients discontinuing prophylaxis after the first 6 months posttransplant. 4,6 These reports gave rise to the recommendation of prescribing PCP prophylaxis throughout all periods of immunocompromise after engraftment. 7 These recommendations, however, do not clearly define parameters that could be used to determine the best time for discontinuing prophylaxis in HSCT recipients, as recent studies have shown a long-lasting defect in CD4 þ T cells in these patients. 8,9 Following the occurrence of PCP among three HSCT recipients in our center in 2002, we decided to undertake a retrospective study of all cases of PCP diagnosed among HSCT recipients within the last 6 years. Patients and methodsIn order to describe the clinical characteristics of recent cases of PCP, we retrospectively reviewed the charts of all patients who underwent an allogeneic HSCT and who developed PCP between January 1997 and December 2002 at our institution. Patients were identified through the computerized records of the laboratory of parasitology, by the identification of P...

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Section: Discussionmentioning

confidence: 99%

Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study

Castro

Neuville

Sarfati

et al. 2005

Bone Marrow Transplant

123

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“…18,19 The development of regimens to prevent fatal opportunistic infections, such as Cytomegalovirus, Epstein-Barr virus infection and Pneumocystis carinii has also improved treatment-related mortality (TRM) after allogeneic stem cell transplantation. [20][21][22][23][24] This report describes our single-center experience of 84 allogeneic stem cell transplants performed in patients with high risk and very high-risk ALL between 1990 and end of 2001. We compared risk factor effects concerning OS, DFS, TRM and relapse rate between stem cell recipients from related and unrelated donors.…”

Section: Introductionmentioning

confidence: 99%

Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation

Dahlke

Kröger

Zabelina

et al. 2005

Bone Marrow Transplant

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We report the results of 84 patients with ALL after related (n ¼ 46) or unrelated (n ¼ 38) allogeneic SCT. Mean recipient age was 23 years (range: 1-60) and median follow-up was 18 months (range: 1-133). Fortythree patients were transplanted in CR1; 25 in CR2 or CR3; four were primary refractory; four in PR; eight in relapse. The conditioning regimen consisted of TBI/ VP16/CY (n ¼ 76), TBI/VP16 (n ¼ 2), TBI/CY (n ¼ 2), Bu/VP16/CY (n ¼ 4). The OS at 3 years was 45% (44% unrelated, 46% related). Univariate analysis showed a significantly better OS for patients o18 years (P ¼ 0.03), mismatched sex-combination (P ¼ 0.03), both with a stronger effect on increasing OS after unrelated SCT. Factors decreasing TRM were patient age o18 years (P ¼ 0.004), patient CMV-seronegativity (P ¼ 0.014), female recipient (P ¼ 0.04). There was no significant difference in TRM and the relapse rate was similar in both donor type groups. Multivariate analysis showed that factors for increased OS which remained significant were mismatched sex-combination (RR: 0.70,95% CI: 0.51-0.93, P ¼ 0.015), patient age o 18 years (RR: 0.66, 95% CI: 0.47-0.93, P ¼ 0.016). A decreased TRM was found for female patients (RR: 0.56, 95% CI: 0.33-0.98, P ¼ 0.042), negative CMV status of the patient (RR: 0.57, 95% CI: 0.36-0.90, P ¼ 0.015). Unrelated stem cell transplantation for high-risk ALL patients with no HLAcompatible family donor is justifiable.

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“…Except for Altintas et al [52] , who showed safe use of inhaled pentamidine in a cardiac transplant patient developing allergic reaction to TMP/SMX, no other studies in this patient group have been identified in the literature. In that study, due to the absence of established guidelines regarding the route and dosage of administration of pentamidine in CT patients, the use of this agent in that patient was based on the use in other patient groups with immunosuppression [53,54] . Since the publication this study in 2011, no other studies have been published.…”

Section: Agents Used For Prophylaxismentioning

confidence: 99%

Pentamidine inPneumocystis jiroveciiprophylaxis in heart transplant recipients

Diken¹,

Diken²,

Hanedan³

et al. 2016

WJT

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Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications.Pneumocystis jirovecii (P. jirovecii ) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii . Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

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Aerosolized pentamidine prophylaxis for Pneumocystis carinii pneumonia after allogeneic marrow transplantation

Cited by 59 publications

References 24 publications

Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study

Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study

Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation

Pentamidine inPneumocystis jiroveciiprophylaxis in heart transplant recipients

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