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Post-Transplant Events

High prevalence of Dapsone-induced oxidant hemolysis in North American SCT recipients without glucose-6-phosphate-dehydrogenase deficiency

Bone Marrow Transplantation volume 47, pages 399–403 (2012)Cite this article

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.

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Authors and Affiliations

  1. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

    H Olteanu, A M Harrington & S H Kroft

  2. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    B George, P N Hari & C Bredeson

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  1. H Olteanu
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  2. A M Harrington
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Correspondence to H Olteanu.

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Olteanu, H., Harrington, A., George, B. et al. High prevalence of Dapsone-induced oxidant hemolysis in North American SCT recipients without glucose-6-phosphate-dehydrogenase deficiency. Bone Marrow Transplant 47, 399–403 (2012). https://doi.org/10.1038/bmt.2011.83

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