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  • Letter to the Editor
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Letters to the Editor

IV pentamidine for Pneumocystis jiroveci pneumonia prophylaxis in pediatric allogeneic stem cell transplant patients

Bone Marrow Transplantation volume 51, pages 1394–1396 (2016)Cite this article

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Prophylaxis for Pneumocystis jiroveci pneumonia (PJP) is essential for patients who are immunocompromised secondary to allogeneic hematopoietic stem cell transplantation (allo-HSCT).1, 2 With PJP prophylaxis, the rate of PJP infection in the immunocompromised patient has significantly diminished.2, 3 Several agents have proven to be effective for PJP prophylaxis, trimethoprim–sulfamethoxazole (TMP–SMX), dapsone, atovaquone and IV or aerosolized pentamidine.4, 5 The current guidelines for PJP prophylaxis in the setting of allo-HSCT recommend TMP–SMX;6 however, this agent is associated with myelosuppressive effects, which can delay engraftment7, 8 and hepatotoxicity. Given these adverse effects, issues of adherence with oral PJP prophylaxis and data showing tolerability and efficacy of IV pentamidine in children diagnosed with HIV,4, 9 the division of HSCT at the Ann and Robert H Lurie Children’s Hospital (formerly Children’s Memorial Hospital) implemented the use of IV pentamidine as a first-line agent for PJP prophylaxis in patients undergoing HSCT. We reviewed this experience to determine the rate of breakthrough PJP while on IV pentamidine, and to assess the adverse effects and tolerability of IV pentamidine in allo-HSCT recipients.

We analyzed the infusion-related adverse effects of IV pentamidine used for PJP prophylaxis in pediatric patients undergoing first allo-HSCT between January 2007 and December 2012. The study was approved by the hospital’s institutional review board. Patient information collected included age, sex, diagnosis before allo-HSCT, development of acute and chronic GvHD, number of IV pentamidine doses administered, interval between doses and incidence of PJP. IV pentamidine was administered as one dose (4 mg/kg/dose) before HSCT followed by one dose every 4 weeks until stable engraftment greater than 100 days post HSCT. Infusions were given over 2 h through indwelling central venous catheters or by peripheral IV. In order to assess efficacy, we excluded patients who received the drug at intervals >6 weeks, who received <3 doses or who received alternative PJP prophylaxis agents.

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Acknowledgements

We thank Dr Stacey Tobin for editorial comment and review, and Dr Xiaotian Zheng for assistance with compiling microbiologic data. JB is supported in part by NIH/NCI training grant T32CA09560.

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Authors and Affiliations

  1. Division of Hematology, Department of Pediatrics, Oncology, Neuro-Oncology and Stem Cell Transplantation, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    D A Curi, R E Duerst, S Chaudhury, M Kletzel, J Schneiderman, W T Tse & N Hijiya

  2. Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    C Badke

  3. Division of Hematology-Oncology, Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    J Bell

  4. Division of Infectious Disease, Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    W J Muller

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  1. D A Curi
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  2. R E Duerst
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Correspondence to R E Duerst.

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Curi, D., Duerst, R., Badke, C. et al. IV pentamidine for Pneumocystis jiroveci pneumonia prophylaxis in pediatric allogeneic stem cell transplant patients. Bone Marrow Transplant 51, 1394–1396 (2016). https://doi.org/10.1038/bmt.2016.133

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