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Cotrimoxazole myelotoxicity in hematopoietic SCT recipients: time for reappraisal

Bone Marrow Transplantation volume 46, pages 1272–1273 (2011)Cite this article

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Cotrimoxazole, a drug combination of Trimethoprim, a folate antagonist, and Sulfamethoxazole, a sulfonamide, is commonly used in recipients of allogeneic hematopoietic SCT (HSCT) as prophylaxis against Pneumocystis jirovecii infection and for reactivation of Toxoplasmosis most commonly at a dose of 3 × 160/800 mg per week with or without folinic acid supplementation.1, 2, 3, 4 Cotrimoxazole is known for myelotoxicity,5, 6, 7, 8 especially after long-term administration as prophylaxis in HIV patients,9 and is therefore used cautiously after HSCT. The impact of this toxicity on neutrophil and platelet engraftment and duration of neutropenia/thrombocytopenia after allogeneic HSCT has not been determined. At our center, the policy to interrupt cotrimoxazole prophylaxis from the day of stem cell infusion (d +0) to hospital discharge (d +30), in order not to slow down engraftment of hematopoietic stem cells (HSCs), has been modified by the physician team from interrupted prophylaxis to continuous prophylaxis after a change in the transplant team directorship and then back again because of prevailing concerns over cotrimoxazole's toxicity in hematopoietic patients (17 patients in total).

This matched pair analysis based on data abstracted from the center database10 compared, using the χ2 statistics for categorical variables and the Mann–Whitney U test for continuous variables, the 17 HSC recipients who received continued cotrimoxazole prophylaxis with 49 controls who received interrupted prophylaxis, matched for donor type (HLA-identical sibling; HLA-matched unrelated donor; HLA-mismatched unrelated donor), disease and age. Each patient was matched with at least two controls depending on the number of patients available in the database of consecutively transplanted patients (2–7, mean 3). The patients and controls were then compared for additional factors that may impact on engraftment, such as conditioning regimen intensity, stem cell source, stem cell dose, GVHD prophylaxis with T-cell depletion, donor–recipient sex combination and donor–recipient CMV serostatus; no differences were found (Table 1).

Table 1 Baseline characteristics in patients and controls
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  1. Hematology Division, Geneva University Hospital, Geneva, Switzerland

    A Fontanet, Y Chalandon, E Roosnek, B Mohty & J R Passweg

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  1. A Fontanet
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  2. Y Chalandon
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Correspondence to J R Passweg.

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Fontanet, A., Chalandon, Y., Roosnek, E. et al. Cotrimoxazole myelotoxicity in hematopoietic SCT recipients: time for reappraisal. Bone Marrow Transplant 46, 1272–1273 (2011). https://doi.org/10.1038/bmt.2010.285

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