ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients

• Published in: Journal of antimicrobial chemotherapy Vol. 71; no. 9; pp. 2397 - 2404
• Main Authors: Maertens, Johan, Cesaro, Simone, Maschmeyer, Georg, Einsele, Hermann, Donnelly, J. Peter, Alanio, Alexandre, Hauser, Philippe M., Lagrou, Katrien, Melchers, Willem J. G., Helweg-Larsen, Jannik, Matos, Olga, Bretagne, Stéphane, Cordonnier, Catherine
• Format: Journal Article
• Language: English
• Published: England Oxford University Press (OUP) 01.09.2016
• Subjects: Antifungal Agents - administration & dosage; Chemoprevention - methods; Hematologic Neoplasms - complications; Hematologic Neoplasms - therapy; Human health and pathology; Humans; Immunocompromised Host; Life Sciences; Pneumonia, Pneumocystis - prevention & control; Stem Cell Transplantation - adverse effects; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkw157

The 5th European Conference on Infections in Leukaemia (ECIL-5) meeting aimed to establish evidence-based recommendations for the prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in non-HIV-infected patients with an underlying haematological condition, including allogeneic HSCT recipients. Recommendations were based on the grading system of the IDSA. Trimethoprim/sulfamethoxazole given 2–3 times weekly is the drug of choice for the primary prophylaxis of PCP in adults (A-II) and children (A-I) and should be given during the entire period at risk. Recent data indicate that children may benefit equally from a once-weekly regimen (B-II). All other drugs, including pentamidine, atovaquone and dapsone, are considered second-line alternatives when trimethoprim/sulfamethoxazole is poorly tolerated or contraindicated. The main indications of PCP prophylaxis are ALL, allogeneic HSCT, treatment with alemtuzumab, fludarabine/cyclophosphamide/rituximab combinations, >4 weeks of treatment with corticosteroids and well-defined primary immune deficiencies in children. Additional indications are proposed depending on the treatment regimen.