Increased incidence of interstitial pneumonia by CHOP combined with rituximab.
Several authors have reported interstitial pneumonia (IP) during rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy, while others have encountered Pneumocystis jirovecii pneumonia during rituximab-combined bi-weekly CHOP. Herein, we report that 13 of 90 (14%) patients developed IP during R-CHOP therapy, compared with none of 105 patients treated with CHOP alone as a historical control. There were no differences in baseline data between patients undergoing the two therapies. Among R-CHOP-treated patients, serum beta-D-glucan was increased in 8 of 12 (75%) IP patients compared with none of 30 non-IP patients examined. In five IP patients who underwent sputum evaluation, two were positive for P. jirovecii by the polymerase chain reaction and another two were positive for Candida albicans. No other organisms were detected as causative pathogens. Treatment with steroids, sulfamethoxazole-trimethoprim (ST), and antifungals was effective. Our results suggest that R-CHOP raises the incidence of IP, possibly through increasing the susceptibility to P. jirovecii and fungal infection. The need for prophylactic antifungals and ST during R-CHOP should be evaluated by randomized controlled trials.
Ennishi
Daisuke
D
Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.|Department of Hematology and Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Terui
Yasuhito
Y
Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Yokoyama
Masahiro
M
Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Mishima
Yuko
Y
Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Takahashi
Shunji
S
Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Takeuchi
Kengo
K
Department of Pathology, The Cancer Institute of the Japanese Foundation of Cancer Research, Tokyo, Japan.
Ikeda
Kazuma
K
Department of Transfusion Medicine, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Tanimoto
Mitsune
M
Department of Hematology and Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Hatake
Kiyohiko
K
Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. khatake@jfcr.or.jp.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001671:Biochemistry; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007167:Immunotherapy; D017563:Lung Diseases, Interstitial / Q000378:metabolism / Q000473:pathology*; D008223:Lymphoma / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone