The increased risk for pneumocystis pneumonia in patients receiving rituximab-CHOP-14 can be prevented by the administration of trimethoprim/ sulfamethoxazole: A single-center experience

Emilia Hardak*, Ilana Oren, Eldad J. Dann, Mordechai Yigla, Tal Faibish, Jacob M. Rowe, Irit Avivi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Recent studies suggest an increased risk for Pneumocystis jirovecii pneumonia (PJP) in adults receiving short-interval rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) therapy for diffuse large cell B cell lymphoma (DLBCL). This retrospective study evaluates precise PJP incidence and the efficacy of anti-PJP prophylaxis in DLBCL. Patients with DLBCL, aged ≥ 18 years and treated between December 2004 and December 2010, were included. Details of treatment-related respiratory infections, focusing on PJP incidence, risk factors and prophylaxis, were assessed. A total of 132 patients were analyzed; 47 were treated with rituximab-CHOP therapy every 21 days (R-CHOP-21) and 85 were treated every 14 days (R-CHOP-14). The incidence of treatment-related respiratory infections was higher in patients receiving R-CHOP-14. PJP was diagnosed in 5 patients: 4 in the R-CHOP-14 (6.6%) and 1 in the R-CHOP-21 cohort (2.6%), using triplex polymerase chain reaction (PCR) for PJ in bronchoalveolar fluid. None of the patients receiving P. jirovecii prophylaxis (n = 33) developed PJP, compared with 6.6% of those treated with R-CHOP-14 without such prophylaxis. An older age and R-CHOP administered every 14 rather than every 21 days increased the PJP risk. Trimethoprim/ sulfamethoxazole prophylaxis is found to be highly efficient in preventing this life-threatening complication and, therefore, should be recommended for patients receiving the RCHOP-14 regimen.

Original languageEnglish
Pages (from-to)110-114
Number of pages5
JournalActa Haematologica
Volume127
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

Keywords

  • Non-Hodgkin lymphoma
  • Pneumocystis pneumonia
  • Prophylaxis
  • Rituximab CHOP regimens

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