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Dapsone for Pneumocystis carinii prophylaxis in children undergoing bone marrow transplantation
H C Maltezou1, D Petropoulos, M Choroszy
1Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston 77030, USA.
Insights
Dapsone effectively prevented Pneumocystis pneumonia (PCP) in pediatric bone marrow transplant (BMT) patients unable to take trimethoprim/sulfamethoxazole. While generally well-tolerated, further evaluation is needed for Toxoplasma gondii encephalitis risk.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Pharmacology
Background:
- Children undergoing bone marrow transplantation (BMT) face a high risk of Pneumocystis pneumonia (PCP).
- Trimethoprim/sulfamethoxazole (TMP/SMX) is a common PCP prophylaxis but has significant adverse drug reactions.
- Alternative prophylactic agents are needed for pediatric BMT patients intolerant to TMP/SMX.
Purpose of the Study:
- To evaluate the efficacy and tolerability of dapsone for Pneumocystis pneumonia (PCP) prophylaxis in pediatric bone marrow transplant (BMT) recipients.
- To assess dapsone as an alternative to trimethoprim/sulfamethoxazole (TMP/SMX) in this vulnerable patient population.
Main Methods:
- Retrospective review of 33 pediatric BMT patients (25 allogeneic, 8 autologous) who received dapsone for PCP prophylaxis.
- Dapsone administered at 50 mg/m2 orally once weekly, with duration varying by transplant type.
- Monitoring for PCP diagnosis, chest radiograph abnormalities, and adverse drug reactions.
Main Results:
- No cases of proven Pneumocystis pneumonia (PCP) were diagnosed during dapsone prophylaxis.
- Sixteen chest radiograph abnormalities were observed, none attributed to PCP.
- Dapsone was well-tolerated with no serious adverse effects, though one patient developed Toxoplasma gondii encephalitis.
Conclusions:
- Dapsone demonstrates efficacy in preventing Pneumocystis pneumonia (PCP) in pediatric bone marrow transplant (BMT) patients.
- Dapsone is a viable alternative for PCP prophylaxis in TMP/SMX-intolerant pediatric BMT patients.
- Consideration for additional prophylaxis against Toxoplasma gondii encephalitis is recommended for high-risk patients.
Abstract:
Children who undergo bone marrow transplantation (BMT) are at risk for Pneumocystis carinii pneumonia (PCP). Prophylaxis using trimethoprim/sulfamethoxazole (TMP/SMX) is highly effective but the incidence of adverse drug reactions is significant. We retrospectively reviewed 33 pediatric BMT (25 allogeneic and eight autologous) in whom dapsone was used for PCP prophylaxis because patients were unable to receive TMP/SMX. Dapsone was administered at 50 mg/m2 p.o. once a week from engraftment to 180 days post-autologous BMT, and to 1 year or throughout the duration of immunosuppressive treatment post-allogeneic BMT. With a total of 7268 patient days of dapsone prophylaxis and a median follow-up of 353 days post-BMT, no proven PCP was diagnosed. Sixteen cases of chest radiograph abnormalities were noted in this patient population but none was attributed to PCP. Dapsone was well tolerated by all children with no serious adverse effects; however, one patient developed Toxoplasma gondii encephalitis during dapsone prophylaxis. Dapsone warrants further evaluation as an alternative for PCP prophylaxis in pediatric BMT patients intolerant of TMP/SMX. Additional prophylaxis should be considered for patients at high risk for T. gondii encephalitis.