Nazir Hanan F, Elshinawy Mohamed, AlRawas Abdulhakim, Khater Doaa, Zadjaly Sherin, Wali Yasser
*Child Health Department ‡Pharmacy Department, Sultan Qaboos University Hospital, Muscat, Oman †Department of Pediatrics, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
J Pediatr Hematol Oncol. 2017 Apr;39(3):203-208. doi: 10.1097/MPH.0000000000000804.
To study dapsone in comparison with trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis jiroveci (PJP) prophylaxis in children with acute lymphoblastic leukemia (ALL).
A retrospective study with a prospective follow-up.
Pediatric ALL patients diagnosed between May 2009 and May 2014, who are still receiving or have completed their maintenance chemotherapy. Patients who completed chemotherapy were prospectively followed up for neutropenia.
TMP/SMX was used as the initial PJP prophylaxis. An alternative drug was indicated if the patient remained cytopenic for >3 weeks. Average absolute neutrophilic count (ANC), average % of oral mercaptopurine (6-MP), and methotrexate doses were calculated over a period of 6 months before and after shifting to dapsone.
Sixty-two ALL patients were eligible for analysis. Twenty-four patients (38.7%) received TMP/SMX for PJP prophylaxis, whereas 34 patients received Dapsone (54.8%). Only 3 patients received IV pentamidine (4.8%), whereas 1 patient (1.6%) received atovaquone. The incidence of prophylaxis failure was 1/1041 months on TMP/SMX and 1/528 months on dapsone. After shifting to dapsone, patients maintained significantly higher ANC (1.46±0.46 vs. 1.17±0.40, P=0.0053), and received significantly higher doses of 6-MP (62.61%±11.45 vs. 57.45±10.14, P=0.0081) and methotrexate (64.9%±14.29 vs. 56.5%±9.9, P=0.0176), with a significantly shorter duration of chemotherapy interruption (1.94±1.2 vs. 3.25±1.29 wk, P=0.0002).
Dapsone for PJP prophylaxis in ALL allowed patients to maintain higher ANC and to receive higher doses of chemotherapy, while maintaining a low incidence of PJP breakthrough infection.
比较氨苯砜与甲氧苄啶/磺胺甲恶唑（TMP/SMX）用于急性淋巴细胞白血病（ALL）患儿预防耶氏肺孢子菌肺炎（PJP）的效果。
一项具有前瞻性随访的回顾性研究。
2009年5月至2014年5月期间确诊的小儿ALL患者，这些患者仍在接受或已完成维持化疗。对完成化疗的患者进行前瞻性中性粒细胞减少随访。
TMP/SMX用作初始PJP预防用药。如果患者血细胞减少持续超过3周，则改用其他药物。计算转换为氨苯砜前后6个月期间的平均绝对中性粒细胞计数（ANC）、口服巯嘌呤（6-MP）的平均百分比以及甲氨蝶呤剂量。
62例ALL患者符合分析条件。24例患者（38.7%）接受TMP/SMX预防PJP，而34例患者接受氨苯砜（54.8%）。仅3例患者接受静脉注射喷他脒（4.8%），而1例患者（1.6%）接受阿托伐醌。TMP/SMX预防失败的发生率为1/1041个月，氨苯砜为1/528个月。转换为氨苯砜后，患者的ANC显著更高（1.46±0.46对1.17±0.40，P=0.0053）,并且接受的6-MP剂量显著更高（分别为62.61%±11.45和57.45±10.14，P=0.0081）以及甲氨蝶呤剂量显著更高（分别为64.9%±14.29和56.5%±9.9，P=0.0176），化疗中断时间显著更短（1.94±1.2对3.25±1.29周，P=0.0002）。
氨苯砜用于ALL患者预防PJP可使患者维持较高的ANC并接受更高剂量的化疗，同时维持较低的PJP突破性感染发生率。
