Toxicity and efficacy of daily dapsone as Pneumocystis jiroveci prophylaxis after hematopoietic stem cell transplantation: a case-control study.
The toxicity and efficacy of dapsone given daily as Pneumocystis jiroveci (PCP) prophylaxis in hematopoietic stem cell transplant (HSCT) recipients who cannot take trimethoprim-sulfamethoxazole (TMP-SMX) have not been fully evaluated. We compared 155 HSCT recipients who received daily dapsone as second-line PCP prophylaxis with 310 matched control patients who received TMP-SMX throughout the posttransplantation course. Among patients who started dapsone before transplantation because of TMP-SMX allergy, there was no difference in the transfusion requirement after HSCT when compared with controls. Among patients who started dapsone after transplantation, increased red blood cell ( P<.0001) and platelet transfusion ( P=.003) requirements were noted compared with controls. This effect was, however, limited to patients who were receiving dapsone for reasons (mostly neutropenia) other than TMP-SMX allergy. Two of 155 patients developed PCP, compared with 0 of 310 controls ( P=.11); both patients survived. In conclusion, the efficacy of daily dapsone in preventing PCP was similar to that observed in patients able to remain on TMP-SMX prophylaxis. Dapsone did not seem to cause hematologic toxicity among TMP-SMX--allergic patients. The observed higher transfusion need in patients who received dapsone for reasons other than TMP-SMX allergy seems mostly due to an underlying condition of poor marrow reserve. Further studies are required to establish whether the drug has an etiologic role in these situations.
Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
Dario
D
Sangiolo
Barry
B
Storer
Richard
R
Nash
Lawrence
L
Corey
Chris
C
Davis
Mary
M
Flowers
Robert C
RC
Hackman
Michael
M
Boeckh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003622:Dapsone / Q000008:administration & dosage*; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016720:Pneumocystis Infections / Q000382:microbiology / Q000517:prevention & control*; D045363:Pneumocystis carinii; D014184:Transplantation, Homologous
D000890:Anti-Infective Agents; D003622:Dapsone