Department of Haematology, Acute Leukaemia and Stem Cell Transplantation Unit, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.
Department of Haematology, Oncoematologia Pediatrica, Policlinico G. B. Rossi, Verona, Italy.
J Antimicrob Chemother. 2016 Sep;71(9):2397-404. doi: 10.1093/jac/dkw157. Epub 2016 May 12.
The 5th European Conference on Infections in Leukaemia (ECIL-5) meeting aimed to establish evidence-based recommendations for the prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in non-HIV-infected patients with an underlying haematological condition, including allogeneic HSCT recipients. Recommendations were based on the grading system of the IDSA. Trimethoprim/sulfamethoxazole given 2-3 times weekly is the drug of choice for the primary prophylaxis of PCP in adults ( A-II: ) and children ( A-I: ) and should be given during the entire period at risk. Recent data indicate that children may benefit equally from a once-weekly regimen ( B-II: ). All other drugs, including pentamidine, atovaquone and dapsone, are considered second-line alternatives when trimethoprim/sulfamethoxazole is poorly tolerated or contraindicated. The main indications of PCP prophylaxis are ALL, allogeneic HSCT, treatment with alemtuzumab, fludarabine/cyclophosphamide/rituximab combinations, >4 weeks of treatment with corticosteroids and well-defined primary immune deficiencies in children. Additional indications are proposed depending on the treatment regimen.
第 5 届欧洲白血病感染会议（ECIL-5）旨在为非 HIV 感染的血液病患者（包括异基因 HSCT 受者）制定预防卡氏肺孢子虫肺炎（PCP）的基于证据的建议。建议是基于 IDSA 的分级系统制定的。复方磺胺甲噁唑每周 2-3 次给药是成人（A-II：）和儿童（A-I：）PCP 一级预防的首选药物，应在整个风险期内使用。最近的数据表明，儿童可能同样受益于每周一次的方案（B-II：）。当复方磺胺甲噁唑不能耐受或禁忌时，所有其他药物，包括喷他脒、阿托伐醌和氨苯砜，均被视为二线选择。PCP 预防的主要适应证是 ALL、异基因 HSCT、用阿仑单抗治疗、氟达拉滨/环磷酰胺/利妥昔单抗联合治疗、>4 周皮质类固醇治疗和儿童明确的原发性免疫缺陷。根据治疗方案提出了其他适应证。
