Naik Priyumvada M, Lyon G Marshall, Ramirez Allan, Lawrence E Clinton, Neujahr David C, Force Seth, Pelaez Andres
Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
J Heart Lung Transplant. 2008 Nov;27(11):1198-202. doi: 10.1016/j.healun.2008.07.025. Epub 2008 Oct 1.
Lung transplant (LT) recipients often receive dapsone for Pneumocystis jirovecii pneumonia (PCP) prophylaxis. However, the prevalence of dapsone-induced hematologic toxicity in LT recipients is unknown. We report a high prevalence of hemolytic anemia (HA) associated with dapsone use in LT patients when compared with other patients described in the literature who have been prescribed dapsone prophylaxis.
We performed a retrospective chart review on all LT recipients who received dapsone prophylaxis between 2004 and 2006. Demographics, ideal body weight (IBW), severity of anemia, transfusion requirements, laboratory evidence of hemolysis, serum creatinine and glucose-6-phosphate deyhdrogenase (G6PD) enzyme levels were collected.
Forty-three patients received dapsone. Ten (22.7%) patients had HA, despite normal G6PD levels. The mean drop in hemoglobin from baseline was 2.7 g/dl (95% confidence interval [CI] 1.9 to 3.5, p < 0.0001). Of those patients with HA, 6 had elevated serum creatinine from baseline. The odds ratio for hemolysis was 4.75 for each 1.0-mg/dl increase in creatinine (95% CI 1.07 to 21.03, p = 0.04). Mean IBW for the HA group was 58.4 kg. A dapsone dose of 100 mg/day orally resulted in a mean dose of 1.7 mg/kg.
The prevalence of dapsone-induced HA in LT recipients is 5-fold higher than the reported rate in the population of human immunodeficiency virus (HIV) patients. Individuals with renal failure or low body weight and for whom dose exceeds 1.5 mg/kg may be at increased risk for dapsone-induced HA. Although current CDC guidelines do not recommend adjusting dose by IBW or renal function, we suggest that consideration should be given to these dosing strategies.
肺移植（LT）受者常接受氨苯砜预防耶氏肺孢子菌肺炎（PCP）。然而，氨苯砜诱发的血液学毒性在LT受者中的发生率尚不清楚。与文献中描述的接受氨苯砜预防治疗的其他患者相比，我们报告了LT患者中与使用氨苯砜相关的溶血性贫血（HA）的高发生率。
我们对2004年至2006年间接受氨苯砜预防治疗的所有LT受者进行了回顾性病历审查。收集了人口统计学资料、理想体重（IBW）、贫血严重程度、输血需求、溶血的实验室证据、血清肌酐和葡萄糖-6-磷酸脱氢酶（G6PD）酶水平。
43例患者接受了氨苯砜治疗。尽管G6PD水平正常，但仍有10例（22.7%）患者发生HA。血红蛋白从基线水平的平均下降幅度为2.7 g/dl（95%置信区间[CI]为1.9至3.5，p<0.0001）。在这些发生HA的患者中，6例患者的血清肌酐较基线水平升高。肌酐每增加1.0 mg/dl，溶血的比值比为4.75（95%CI为1.07至21.03，p = 0.04）。HA组的平均IBW为58.4 kg。口服氨苯砜剂量为100 mg/天，平均剂量为1.7 mg/kg。
LT受者中氨苯砜诱发的HA发生率比人类免疫缺陷病毒（HIV）患者群体中报告的发生率高5倍。肾功能衰竭或体重低且剂量超过1.5 mg/kg的个体可能发生氨苯砜诱发的HA的风险增加。尽管目前疾病预防控制中心（CDC）的指南不建议根据IBW或肾功能调整剂量，但我们建议应考虑这些给药策略。
