Fatal pneumocystis jiroveci pneumonia in ABVD-treated Hodgkin lymphoma patients

Abstract

International audienc

Consensus guidelines for diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies, 2014

“…Patients in whom the risk of PJP is not conclusively established, but is likely to be moderate, include those with autologous bone marrow transplant, and patients with haematological malignancy undergoing certain high‐intensity chemotherapy regimens. In the latter case, clinicians should be particularly vigilant of R‐CHOP14 (rituximab, cyclophosphamide, adriamycin, vincristine, prednisolone chemotherapy on a 14‐day cycle), FCR (fludarabine, cyclophosphamide, rituximab), AVBD (adriamycin, vincristine, bleomycin, dexamethasone), gemcitabine and high‐dose methotrexate. Patients with prolonged CD4 lymphopenia, before or after initiation of chemotherapy, are also likely to be at moderate risk of PJP.…”

How we treat elderly patients with Hodgkin lymphoma

“…Granulocyte colony stimulating factor (G-CSF) secondary prophylaxis should be avoided because of the increased risk of bleomycin-related toxicity [22] and a better life-expectancy with no G-CSF use [23]. If more than four cycles of ABDV (or CHOP see below) are given, we choose to give Pneumocystis jirovecii (PCP) prophylaxis [24]. The best option for fit patients 60-70 years of age with advanced disease (IIB, III, and IV) we believe is six to eight courses of ABVD chemotherapy irrespective of risk according to the international prognostic score.…”

Pneumocystis Pneumonia in Non-HIV Pregnant Women Receiving Chemotherapy for Malignant Lymphoma: Two Case Reports

“…Moreover, the frequency of PCP in patients who are given ABVD is currently unknown. The only literature that we found involved five patients with PCP and Hodgkin's lymphoma who were treated with ABVD [ 11 ]. Nevertheless, we have encountered two cases of PCP following ABVD or R-CHOP therapy.…”