title: Atovaquone for Prophylaxis of Toxoplasmosis after Allogeneic Hematopoietic Stem Cell Transplantation.
abstract: Toxoplasmosis and infections by other opportunistic agents such as Pneumocystis jirovecii constitute life-threatening risks for patients after allogeneic hematopoietic stem cell transplantation. Trimethoprim/sulfamethoxazole (TMP-SMX) has been well established for post-transplant toxoplasmosis and pneumocystis prophylaxis, but treatment may be limited due to toxicity. We explored atovaquone as an alternative and compared it with TMP-SMX regarding toxicity and efficacy during the first 100 days after transplantation in 155 consecutive adult stem cell recipients. Eight patients with a prior history of TMP-SMX intolerance received atovaquone as first-line prophylaxis. TMP-SMX was used for 141 patients as first-line strategy, but 13 patients (9.2%) were later switched to atovaquone due to TMP-SMX toxicity or gastrointestinal symptoms. No active toxoplasmosis or active P. jirovecii infection developed under continued prophylaxis with either TMP-SMX or atovaquone. However, for reasons of TMP-SMX and/or atovaquone toxicity, 7 patients were unable to tolerate any efficacious toxoplasmosis prophylaxis and therefore obtained inhalative pentamidine as P. jirovecii prophylaxis but no toxoplasmosis prophylaxis. Importantly, 2 of these patients developed severe toxoplasmosis. In summary, atovaquone appears as a valid alternative for at least some post-transplant patients who cannot tolerate TMP-SMX. This should be further confirmed by multicenter trials.
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mendorf
authors.forename: Evgeny
authors.initials: E
authors.lastname: Klyuchnikov
authors.forename: Claudia
authors.initials: C
authors.lastname: Langebrake
authors.forename: Holger
authors.initials: H
authors.lastname: Rohde
authors.forename: Francis
authors.initials: F
authors.lastname: Ayuk
authors.forename: Marc
authors.initials: M
authors.lastname: Regier
authors.forename: Maximilian
authors.initials: M
authors.lastname: Christopeit
authors.forename: Tatjana
authors.initials: T
authors.lastname: Zabelina
authors.forename: Adelbert
authors.initials: A
authors.lastname: Bacher
authors.forename: Thomas
authors.initials: T
authors.lastname: Stübig
authors.forename: Christine
authors.initials: C
authors.lastname: Wolschke
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053626:Atovaquone / Q000009:adverse effects / Q000627:therapeutic use*; D001927:Brain Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014123:Toxoplasmosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D014184:Transplantation, Homologous; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D053626:Atovaquone