title: Opportunistic pulmonary infections with fludarabine in previously treated patients with low-grade lymphoid malignancies: a role for Pneumocystis carinii pneumonia prophylaxis.
abstract: The high incidence of opportunistic pulmonary infections in fludarabine-treated patients at Walter Reed Army Medical Center (WRAMC) and in the literature are described. A CancerLit search of fludarabine from June 1983-April 1994 with subsequent cross referencing and a retrospective review of all patients receiving fludarabine at WRAMC was performed. A total of 2,269 patients with low-grade lymphoid malignancies who received 7,547 + cycles of fludarabine were identified from the literature. Seventy-three (3.2%) of these patients developed opportunistic infections. Seventy-one (97%) of these infections occurred in patients who were pretreated with alkylator regimens or corticosteroids. Forty-five (2%) of these were of respiratory origin and associated with a 56% mortality rate. In contrast, 6 of the 21 patients (29%) treated with fludarabine at WRAMC developed opportunistic pulmonary infections which included three Pneumocystis carinii (PCP), one PCP/disseminated Candidiasis, one Mycobacterium avium intracellulare, and one Aspergillus niger pneumonia. These infections developed during and after treatment with fludarabine in alkylator-resistant patients who had received corticosteroids before (n = 6), during (n = 1), or after (n = 4) fludarabine therapy. Lack of PCP prophylaxis was the only significant (P = .018) variable that differentiated patients who developed opportunistic pulmonary infections. Corticosteroid treatment before, during, or after fludarabine treatment in patients with alkylator-resistant, low-grade lymphoid malignancies who have not received PCP prophylaxis is associated with an increased risk of opportunistic pulmonary infections. Aggressive work-up of pulmonary syndromes and PCP prophylaxis in these patients should be considered during and after treatment with fludarabine.
authors.affiliation: Hematology-Oncology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Byrd
authors.forename: J B
authors.initials: JB
authors.lastname: Hargis
authors.forename: K E
authors.initials: KE
authors.lastname: Kester
authors.forename: D R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: S W
authors.initials: SW
authors.lastname: Knutson
authors.forename: L F
authors.initials: LF
authors.lastname: Diehl
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D001999:Bronchoscopy; D006801:Humans; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000139:chemically induced / Q000175:diagnosis; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D015337:Multicenter Studies as Topic; D009894:Opportunistic Infections / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000517:prevention & control*; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine