Weinthal J, Frost J D, Briones G, Cairo M S
Division of Hematology/Oncology, Children's Hospital of Orange County, CA 92668.
J Clin Oncol. 1994 Jan;12(1):136-40. doi: 10.1200/JCO.1994.12.1.136.
We report our experience replacing trimethoprim-sulfamethoxazole (TMP/SMX) with aerosolized pentamidine (AP) in 22 children with acute leukemia who could not tolerate TMP/SMX.
Children (age 1 to 15 years) with acute leukemia during maintenance chemotherapy or post-bone marrow transplantation (BMT) receiving prophylaxis for Pneumocystis carinii pneumonia (PCP) with TMP/SMX received AP following prolonged neutropenia or allergy to TMP/SMX. Patients received 300 mg of AP monthly (children < 4 years received 150 mg) dissolved in 5 mL of distilled water over 20 to 30 minutes.
Over a 3-year period, 358 courses of AP were administered over 10,124 observable days. AP was adequately tolerated on a monthly basis for prophylaxis against PCP in 22 children with acute leukemia. AP was demonstrated to be effective in preventing PCP. There were minimal side effects observed during this trial. The majority of children with acute lymphoblastic leukemia (ALL; 12 of 14 [86%]) undergoing maintenance chemotherapy were able to resume full-dose therapy.
AP in children is well tolerated and shows high efficacy for PCP prophylaxis in children with leukemia. We conclude that AP should be considered as second-line PCP prophylactic therapy for children with acute leukemia in instances in which TMP/SMX cannot be tolerated. Phase III trials are required to determine its effect on dose intensification and event-free survival.
我们报告了在22例不能耐受甲氧苄啶-磺胺甲恶唑（TMP/SMX）的急性白血病患儿中，用气雾化戊烷脒（AP）替代TMP/SMX的经验。
年龄在1至15岁的急性白血病患儿，在维持化疗期间或骨髓移植（BMT）后接受TMP/SMX预防卡氏肺孢子虫肺炎（PCP），在出现长期中性粒细胞减少或对TMP/SMX过敏后接受AP治疗。患者每月接受300毫克AP（4岁以下儿童接受150毫克），溶于5毫升蒸馏水中，在20至30分钟内给药。
在3年期间，在10124个可观察日里共进行了358个疗程的AP治疗。22例急性白血病患儿每月接受AP预防PCP时耐受性良好。AP被证明对预防PCP有效。在该试验期间观察到的副作用极小。大多数接受维持化疗的急性淋巴细胞白血病（ALL；14例中的12例[86%]）患儿能够恢复全剂量治疗。
儿童对AP耐受性良好，对白血病患儿预防PCP显示出高效性。我们得出结论，在不能耐受TMP/SMX的情况下，AP应被视为急性白血病患儿PCP预防的二线治疗方法。需要进行III期试验以确定其对剂量强化和无事件生存期的影响。
