Low incidence of pneumocystis pneumonia utilizing PCR‐based diagnosis in patients with B‐cell lymphoma receiving rituximab‐containing combination chemotherapy

Abstract

Recent literature has demonstrated concern over the risk of Pneumocystis jirovecii pneumonia (PJP) when administering rituximab with combination chemotherapy such as in R-CHOP; however, the exact risk and potential need for prophylaxis is unknown. We sought to determine the incidence of PJP infection following R-CHOP administration in patients with B-cell lymphoma. Consecutive patients diagnosed with B-cell lymphoma receiving R-CHOP were evaluated from chemotherapy initiation until 180 days after the last administration. The primary outcome was cumulative incidence of PJP infection. Secondary endpoints included the association of rituximab, prednisone and subsequent chemotherapy with PJP infection risk. A total of 689 patients (53% male, median age 66 years) were included. Seventy-three percent of patients completed at least 6 cycles of R-CHOP treatment. Median rituximab and prednisone cumulative doses were 3950 mg and 5325 mg, respectively. Median daily prednisone dose through end of treatment was 45 mg (range 7.6 mg to 119 mg). The cumulative incidence of PJP was 1.51% (95% CI 0.57-2.43, at maximum follow-up of 330 days), below 3.5%, the conventional threshold for prophylaxis. Univariate analysis did not detect a statistically significant association between PJP and rituximab, steroids, or receipt of additional chemotherapy in this patient population. Our results demonstrate a low occurrence of Pneumocystis pneumonia during R-CHOP treatment of B-cell lymphoma and argue against universal anti-Pneumocystis prophylaxis in this setting. Further investigations should focus on targeted anti-Pneumocystis prophylaxis for patients presenting with high-risk baseline characteristics or when receiving rituximab-inclusive intensive combination chemotherapy regimens as treatment for other aggressive lymphoma subtypes. Am. J. Hematol. 91:1113-1117, 2016. © 2016 Wiley Periodicals, Inc.

Pneumocystis jirovecii pneumonia in HIV-uninfected, rituximab treated non-Hodgkin lymphoma patients

“…Thus, when rituximab is administered for various diseases, regular pneumocystis prophylaxis with TMP/SMX is widely recommended by many treatment guidelines, such as Wegener’s granulomatosis and organ or haematopoietic transplant 15 , 16 . However, the necessity of pneumocystis prophylaxis for HIV-uninfected, rituximab-treated non-Hodgkin lymphoma (NHL) patients remains controversial because the benefits and risks of prophylaxis have not been assessed in a large-scale study 4 , 10 , 17 . Thus, in this report, we investigated the beneficial effect of pneumocystis prophylaxis with oral TMP/SMX in HIV-uninfected NHL patients by analysing data from a national registry, the Taiwan National Health Insurance Research Database (NHIRD).…”

T-cell lymphoma with abundant CD20 expression showing a good response to rituximab with gemcitabine, oxiplatin, and L-asparaginase (R-pGEMOX)

“…Pneumonia was previously reported during rituximab treatment; it is thought to be induced by B-cell deficiency or a yet undetermined mechanism of rituximab. [ 12 , 13 ] No new adverse reactions were observed in this case. The pneumonia improved after antibiotics treatment.…”

Incidence of Pneumocystis jirovecii pneumonia utilizing a polymerase chain reaction‐based diagnosis in patients receiving bendamustine

“…Individual studies and a systematic review and meta-analysis using various databases have demonstrated a low overall incidence of PJP in the setting of rituximab-inclusive treatments. [35][36][37] Due to the retrospective nature of this work, it is impossible to determine if this finding represents selection bias by providers who may have been less inclined to prescribe aggressive, intensive combination chemotherapy to patients with comorbid conditions and a Univariate analysis incorporating steroids into chemotherapy was impossible as it would include nearly every patient in our cohort and the low overall incidence of PJP in our patient cohort precluded multivariable analysis to assess if there was additional risk conferred by any particular bendamustinebased combination regimen. Agents commonly used for prophylaxis have considerable adverse event profiles.…”