Pneumocystis jiroveci prophylaxis in patients undergoing Bendamustine treatment: the need for a standardized protocol

Abkur, Tarig Mohammed; Saeed, Mamoun; Ahmed, Saad Z; McArthur, Ryan; Leahy, Martin J.; O'Leary, Hilary; O’Keeffe, Denis

doi:10.1002/ccr3.195

Cited by 11 publications

(14 citation statements)

References 22 publications

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“…No treatment-related deaths were reported; however, major grade 3/4 toxicities included lymphopenia (97%), CD4 lymphopenia (91%), neutropenia (86%), and leukopenia (83%). Of note, bendamustine is associated with a reduction in CD4 lymphocyte counts and an increased risk of opportunistic infections [52].…”

Section: Advanced Stage Diseasementioning

confidence: 99%

Treatment of mantle cell lymphoma in Asia: a consensus paper from the Asian Lymphoma Study Group

et al. 2020

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Background: Mantle cell lymphoma (MCL) is a B cell malignancy that can be aggressive and with a poor prognosis; the clinical course is heterogeneous. The epidemiology of MCL in Asia is not well documented but appears to comprise 2-6% of all lymphoma cases based on available data, with variation observed between countries. Although international guidelines are available for the treatment of MCL, there is a lack of published data or guidance on the clinical characteristics and management of MCL in patient populations from Asia. This paper aims to review the available treatment and, where clinical gaps exist, provide expert consensus from the Asian Lymphoma Study Group (ALSG) on appropriate MCL management in Asia. Body: Management strategies for MCL are patient-and disease stage-specific and aim to achieve balance between efficacy outcomes and toxicity. For asymptomatic patients with clearly indolent disease, observation may be an appropriate strategy. For stage I/II disease, following international guidelines is appropriate, which include either a short course of conventional chemotherapy followed by consolidated radiotherapy, less aggressive chemotherapy regimens, or a combination of these approaches. For advanced disease, the approach is based on the age and fitness of the patient. For young, fit patients, the current practice for induction therapy differs across Asia, with cytarabine having an important role in this setting. Hematopoietic stem cell transplantation (HSCT) may be justified in selected patients because of the high relapse risk. In elderly patients, specific chemoimmunotherapy regimens available in each country/region are a treatment option. For maintenance therapy after first-line treatment, the choice of approach should be individualized, with cost being an important consideration within Asia. For relapsed/ refractory disease, ibrutinib should be considered as well as other follow-on compounds, if available. Conclusion: Asian patient-specific data for the treatment of MCL are lacking, and the availability of treatment options differs between country/region within Asia. Therefore, there is no clear one-size-fits-all approach and further investigation on the most appropriate sequence of treatment that should be considered for this heterogeneous disease.

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Section: Advanced Stage Diseasementioning

confidence: 99%

Treatment of mantle cell lymphoma in Asia: a consensus paper from the Asian Lymphoma Study Group

et al. 2020

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“…The risk of infection associated with bendamustine has yet to be fully characterized. Small series and case reports have reported the occurrence of Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) after bendamustine exposure [19][20][21][22]. Some clinical trials suggested that bendamustine plus rituximab (BR) was associated with fewer infections than cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-CHOP) [12,13], but the same risk of infection as fludarabine and rituximab [14].…”

mentioning

confidence: 99%

Increased Risk of Infectious Complications in Older Patients With Indolent Non-Hodgkin Lymphoma Exposed to Bendamustine

Fung

Jacobsen

Freedman

et al. 2018

Clinical Infectious Diseases

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“…Four cases of PJP were described in one Irish institution in patients following R‐bendamustine treatment in patients who were elderly, heavily pretreated or who received doses of bendamustine in excess of the standard 90 mg/m 2 typically used . A multicenter retrospective analysis of a cohort of patients in Israel treated with any bendamustine containing regimen over 5 years found that viral infections occurred in 11.3% of patients, of which 2.1% experienced HSV and 3.0% VZV infections . In addition, fluconazole can be prescribed in the small subset of patients, generally only older patients administered steroid containing regimens, who develop clinical thrush.…”

Section: Best Practice Guidance For Managing Patients Receiving Obinumentioning

confidence: 99%

Management of patients with follicular lymphoma treated first line with obinutuzumab

Opat

Dickinson

Cheah

et al. 2019

Asia-Pac J Clncl Oncology

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Recently, obinutuzumab was included in the Australian Pharmaceutical Benefits Scheme for use in first line, advanced or bulky stage 2, follicular lymphoma, providing more immunochemotherapy treatment options available than ever before. Rituximab with chemotherapy has been the standard of care since reimbursement in the late 1990s; however, obinutuzumab‐based regimens have shown superior progression‐free survival in comparison to rituximab‐based options, albeit at an increased risk of grade ≥3 adverse events. As median overall survival approaches 20 years or more, the long‐term effects and sequencing of any strategy should be considered. Here we discuss the considerations for selection of front‐line therapy, based on evidence and local Australian clinician experience, in the management of first line follicular lymphoma.

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Pneumocystis jiroveci prophylaxis in patients undergoing Bendamustine treatment: the need for a standardized protocol

Cited by 11 publications

References 22 publications

Treatment of mantle cell lymphoma in Asia: a consensus paper from the Asian Lymphoma Study Group

Treatment of mantle cell lymphoma in Asia: a consensus paper from the Asian Lymphoma Study Group

Increased Risk of Infectious Complications in Older Patients With Indolent Non-Hodgkin Lymphoma Exposed to Bendamustine

Management of patients with follicular lymphoma treated first line with obinutuzumab

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