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IV pentamidine for primary PJP prophylaxis in adults undergoing allogeneic hematopoietic progenitor cell transplant

Bone Marrow Transplantation volume 50, pages 1253–1255 (2015)Cite this article

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Pneumocystis jirovecii pneumonia (PJP) contributes to significant mortality and morbidity in immunosuppressed patients. Patients who have undergone allogeneic hematopoietic progenitor cell (HPC) transplant are, therefore, highly susceptible to PJP. Further suppression of the immune systems occurs when corticosteroids and other secondary immunosuppressive agents are added to treat GVHD to those given for GVHD prophylaxis. It has been estimated that up to 16% of HPC transplant recipients develop PJP if chemoprophylaxis is not given to these patients.1 The mortality rates have varied, with rates as high as 89%.2 Pre-emptive PJP prophylaxis in this group of high-risk patients is appropriate.

The most commonly used prophylactic agent is the combination of trimethoprim/sulfamethoxamide (TMP-SMZ). Although it is effective, adverse reactions such as skin rash, nausea and vomiting are common. Furthermore, it potentially suppresses the regenerating bone marrow. Up to 47% of HIV patients required an alternative to TMP-SMZ because of side effects.3 Dapsone is better tolerated but is associated with a high breakthrough infection rate of 7.2%.4 Nebulized pentamidine provides an alternative, with a breakthrough infection rate of between 1.2 and 2.7%.5, 6 However, the administration of nebulized pentamidine requires specialized equipment and personnel.

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Authors and Affiliations

  1. Adult Hematopoietic Stem Cell Transplant Program, Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,

    M J Lim, A Stebbings, S J Lim, K Foor, J-Z Hou, R Farah, A Raptis, S Marks, D Weber, A Im, K Dorritie, A Sehgal, M Agha & S H Lim

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  1. M J Lim
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  2. A Stebbings
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Correspondence to S H Lim.

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Lim, M., Stebbings, A., Lim, S. et al. IV pentamidine for primary PJP prophylaxis in adults undergoing allogeneic hematopoietic progenitor cell transplant. Bone Marrow Transplant 50, 1253–1255 (2015). https://doi.org/10.1038/bmt.2015.131

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