An analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital

Abstract

Pneumocystis jirovecii pneumonia (PCP) is associated with high mortality in immunocompromised patients without human immunodeficiency virus infection. However, chemoprophylaxis is highly effective. In patients with solid tumours or haematologic malignancy, several risk factors for developing PCP have been identified, predominantly corticosteroid therapy. The aims of this study were to identify the potentially preventable cases of PCP in patients receiving corticosteroid therapy at a tertiary care cancer centre and to estimate the frequency of utilisation of chemoprophylaxis in these patients. Two retrospective reviews were performed. Over a 10-year period, 14 cases of PCP were identified: no cases were attributable to failed chemoprophylaxis, drug allergy or intolerance. During a 6-month period, 73 patients received high-dose corticosteroid therapy (X25 mg prednisolone or X4 mg dexamethasone daily) for X4 weeks. Of these, 22 (30%) had haematologic malignancy, and 51 (70%) had solid tumours. Fewer patients with solid tumours received prophylaxis compared to patients with haematologic malignancy (3.9 vs 63.6%, Po0.0001). Guidelines for PCP chemoprophylaxis in patients with haematologic malignancy or solid tumours who receive corticosteroid therapy are proposed. Successful primary prevention of PCP in this population will require a multifaceted approach targeting the suboptimal prescribing patterns for chemoprophylaxis.

Fludarabine, cyclophosphamide, and rituximab for the treatment of patients with chronic lymphocytic leukemia or indolent non‐hodgkin lymphoma

“…27 Such regimens, however, were limited by a modest risk of Pneumocytis jiroveci pneumonia 28 related to the use of corticosteroids. 18,29,30 Moreover, the use of mitoxantrone as initial therapy may limit the later use of anthracyclines as salvage treatment. FC-R, which does not contain anthracycline or related compounds, and which is associated with a low risk of opportunistic infections, 31 may therefore be preferable.…”

“…When available, patients with CLL were also evaluated for ZAP-70 expression by flow cytometry. 14 In addition, some patients underwent functional imaging with 18 FDG-positron emission tomography (PET) 15 and determination of submorphologic disease using flow cytometry and/or molecular studies. The outcome of 5 patients with Waldenstrom macroglobulinemia has been previously reported.…”

“…Patients did not receive Pneumocystis jiroveci (PCP) prophylaxis in the absence of significant corticosteroid exposure or a prior episode of proven PCP. 18 Treatment duration was planned for a total of 4 to 6 courses or until attainment of maximum response.…”

Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

“…Pneumocystis jiroveci typically causes pneumonia (PCP) and is an opportunistic infection associated with immune impairment such as occurs with advanced Human Immunodeficiency Virus (HIV) infection. However, PCP is of increasing concern in the HIV-negative population, including oncology patients, where its incidence is rising and its mortality reaches 50 % in some studies [3].…”

Limiting early mortality: Do's and don'ts in the management of patients with newly diagnosed multiple myeloma

“…If 20 mg or more of prednisone per day is administered, the use of TMP-SMX for pneumocystis jirovecci prophylaxis is recommended [62]. Treatment with proteasome inhibitors like bortezomib has been found to disrupt normal T-cell immunity predisposing MM patients to varicella zoster reactivation [63].…”