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Penatmidine prevented pneumocystosis among pediatric HSCT patients
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Intravenous pentamidine was found to be safe and effective for the prevention of pneumocystis carinii pneumonia in pediatric hematopoietic stem cell transplantation patients, according to findings of a retrospective study.
Pneumocystis carinii pneumonia (PCP) represents a significant cause of morbidity and mortality in immunocompromised patients without chemoprophylaxis, especially among children after hematopoietic stem cell transplantation (HSCT), in which patients may be profoundly immunocompromised due to their underlying diagnosis and previous therapy, delayed immune reconstitution due to poor engraftment or the development of graft-versus-host disease.
“The incidence of PCP in pediatric HSCT recipients has been reported to be as high as 45% with an associated mortality of nearly 89% without appropriate prophylaxis,” the researchers wrote.
To evaluate the safety and efficacy of IV pentamidine in preventing PCP in the post-transplant period, the researchers retrospectively reviewed the medical records of 137 children who underwent HSCT from 2005 to 2011 and received pentamidine as first-line PCP prophylaxis at admission.
According to study results, 167 consecutive HSCTs in 137 pediatric patients were administered IV pentamidine before myeloablation and then every 28 days until the patient was at least a minimum 30 days post-HSCT.
Patients in this study exhibited stable neutrophil engraftment (absolute neutrophil count >1,000/mm2 for 3 days without growth factor support), whereas allogeneic patients reported no evidence of active graft-versus-host disease and weaning on immunosuppressive therapy.
Twelve adverse events in 12 children related to pentamidine were reported, including 10 (7%) children experienced nausea and vomiting and two patients (2%) developed anaphylactic reactions, with one necessitating management with IV epinephrine and transfer to intensive care. In addition, one patient required discontinuation of IV pentamidine, and another patient was changed to aerosolized pentamidine without further allergic reactions.
“In contrast to prior reports, children younger than 2 years of age did not appear to have an increased susceptibility to PCP and the use of IV pentamidine appears safe in this age group,” the researchers wrote. “Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration, and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first-line therapy for the prevention of PCP in children undergoing HSCT.”
Disclosure: The researchers reported no relevant financial disclosures.
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