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

• Published in: Acta haematologica Vol. 127; no. 2; p. 110
• Main Authors: Hardak, Emilia, Oren, Ilana, Dann, Eldad J, Yigla, Mordechai, Faibish, Tal, Rowe, Jacob M, Avivi, Irit
• Format: Journal Article
• Language: English
• Published: Switzerland 01.01.2012
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antibodies, Monoclonal, Murine-Derived - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Female; Humans; Lymphoma, Large B-Cell, Diffuse - complications; Lymphoma, Large B-Cell, Diffuse - drug therapy; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis - prevention & control; Prednisone - administration & dosage; Prednisone - adverse effects; Retrospective Studies; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 1421-9662
• DOI: 10.1159/000334113

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 R-CHOP-14 regimen.