Department of Hematology and Oncology, Anjo Kosei Hospital, 28 Higashihirokute, Anjo-cho, Anjo, Aichi, 446-8602, Japan.
Clin Exp Med. 2023 Aug;23(4):1285-1291. doi: 10.1007/s10238-022-00868-3. Epub 2022 Aug 17.
The effectiveness and safety of trimethoprim/sulfamethoxazole (TMP/SMX) desensitization therapy is insufficiently evaluated in hematological diseases. From 2002 to 2019, we retrospectively analyzed 112 patients with hematological diseases who underwent desensitization therapy after TMP/SMX prophylaxis withdrawal due to adverse events. They orally started TMP/SMX at 0.4 mg/2 mg, which was then increased daily to 80 mg/400 mg for 5 or 9 days. Eighty-eight patients (79%) had complete desensitization, and the major reason for failure was rash seen in 21 cases (19%). The cause of desensitization and reasons for failure matched in 22 cases (92%). Pneumocystis pneumonia was not observed throughout the study. In the failure group, the number of eosinophils and alanine aminotransferase (ALT) levels were significantly increased after desensitization. In particular in the failure group, the slight increase in eosinophils was seen through the beginning to halfway during desensitization (36/μL (0-900/μL) and 48/μL (0-2560/μL), respectively, p = 0.025). These data show that TMP/SMX desensitization therapy is effective and safe in hematological diseases. The recurrence of adverse events could help predict desensitization success.
在血液病中，复方磺胺甲噁唑（TMP/SMX）脱敏治疗的有效性和安全性评价不足。2002 年至 2019 年，我们回顾性分析了 112 例因不良反应而停用 TMP/SMX 预防后接受脱敏治疗的血液病患者。他们口服 TMP/SMX 起始剂量为 0.4mg/2mg，每天增加至 80mg/400mg，持续 5 或 9 天。88 例（79%）患者完全脱敏，失败的主要原因是 21 例（19%）出现皮疹。脱敏原因和失败原因在 22 例（92%）中匹配。整个研究过程中未观察到卡氏肺孢子虫肺炎。在失败组中，脱敏后嗜酸性粒细胞和丙氨酸氨基转移酶（ALT）水平显著升高。特别是在失败组中，脱敏开始到中途时，嗜酸性粒细胞稍有增加（分别为 36/μL（0-900/μL）和 48/μL（0-2560/μL），p=0.025）。这些数据表明，TMP/SMX 脱敏治疗在血液病中是有效且安全的。不良反应的复发有助于预测脱敏治疗的成功。
