title: High prevalence of Dapsone-induced oxidant hemolysis in North American SCT recipients without glucose-6-phosphate-dehydrogenase deficiency.
abstract: Dapsone (4-4'-diaminodiphenylsulfone) is commonly used for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in immunocompromised patients. Oxidant hemolysis is a known complication of dapsone, but its frequency in adult patients who have undergone a SCT for hematological malignancies is not well established. We studied the presence of oxidant hemolysis, by combining examination of RBC morphology and laboratory data, in 30 patients who underwent a SCT and received dapsone for PCP prophylaxis, and compared this group with 26 patients who underwent a SCT and received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. All patients had normal glucose-6-phosphate dehydrogenase (G6PDH) enzymatic activity. In SCT patients, dapsone compared with TMP-SMX for PCP prophylaxis was associated with a high incidence of oxidant hemolysis (87 vs 0%, P<0.001), and the morphological evaluation of oxidant hemolysis correlated well with laboratory evidence of hemolysis. Dapsone-induced oxidant hemolysis in SCT patients is 20-fold higher than the reported rate in the population of HIV-infected patients, and thus much higher than the prevalence of G6PDH variants in the general population. In our patients, it manifested clinically as a lower Hb that was not significant enough to result in increased packed RBC transfusions.
authors.affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA. holteanu@mcw.edu
authors.forename: H
authors.initials: H
authors.lastname: Olteanu
authors.forename: A M
authors.initials: AM
authors.lastname: Harrington
authors.forename: B
authors.initials: B
authors.lastname: George
authors.forename: P N
authors.initials: PN
authors.lastname: Hari
authors.forename: C
authors.initials: C
authors.lastname: Bredeson
authors.forename: S H
authors.initials: SH
authors.lastname: Kroft
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000494:pharmacology; D003622:Dapsone / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005954:Glucosephosphate Dehydrogenase / Q000378:metabolism*; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000175:diagnosis*; D006454:Hemoglobins / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D016877:Oxidants / Q000737:chemistry* / Q000378:metabolism; D015995:Prevalence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology
chemical_list: D000890:Anti-Infective Agents; D006454:Hemoglobins; D016877:Oxidants; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone; D005954:Glucosephosphate Dehydrogenase