Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
Successful Pneumocystis carinii pneumonia prophylaxis using aerosolized pentamidine in pediatric leukemia patients undergoing immunosuppressive chemotherapy (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 12:A1587 1993. Unique Identifier : AIDSLINE ICDB/94695986 Weinthal J; Briones G; Gillan E; Hodder F; Cairo MS; Children's Hosp. of Orange County, Orange, CA
Abstract:
Pneumocystic carinii pneumonia (PCP) was the most common cause of death in leukemia patients (pts) in remission treated with intensive multiagent chemotherapy until the advent of chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP/SMX; Hughes, NEJM 316:1627, 1987) Previous attack rates in pts not given PCP prophylaxis have ranged as high as 15-21% (Baehner, AJDC 134:35, 1980) However, TMP/SMX used in prophylactic doses has been associated with allergic reactions, rash, fever, nausea, and most importantly, bone marrow suppression. Recently, aerosolized pentamidine (AP) has been shown to provide effective PCP prophylaxis in adult pts with HIV (Leoung, NEJM 323:769, 1990). However, no data has been reported regarding the efficacy and toxicity of AP in children with leukemia treated with intensive multiagent immunosuppressive chemotherapy. We now report our experience with AP in 18 children (6 mo to 16 yr of age) with acute leukemia at our institution who did not tolerate TMP/SMX PCP prophylaxis because of persistent neutropenia resulting in delays in their chemotherapy. 16 of the children had ALL, while 2 had ANLL; all were in remission and receiving intensification and/or maintenance chemotherapy. Five of the pts also went on to receive a bone marrow transplant and were continued on AP prophylaxis following transplant. Pts were treated with 300 mg of AP monthly (children less than 4 yr of age received 150 mg of AP) delivered by a Respirgard II inhaler within a Peace demistifier HEPA-filtered tent. There have been 309 monthly courses of AP given to the 18 pts over 9307 observable days at risk of PCP. AP has provided 100% successful prophylaxis of PCP during this time period. All pts were able to resume maintenance chemotherapy following the switch from TMP/SMX to AP. The toxicity has been minimal with this regimen. Two pts have experienced coughing and wheezing with AP and were treated with aerosolized bronchodilators following their AP. Two pts complained of nausea following AP which resolved within 60 min. There were no other side effects of AP therapy. This pilot study demonstrates that AP given to children with acute leukemia who are at high risk for PCP provides effective chemoprophylaxis for those pts who cannot tolerate TMP/SMX and allows resumption of full-dose chemotherapy.
Keywords: Administration, Inhalation Adolescence Antineoplastic Agents, Combined/*ADVERSE EFFECTS Child Child, Preschool Human Immunosuppression/*ADVERSE EFFECTS Infant Leukemia/*DRUG THERAPY Leukemia, Lymphocytic, Acute, L1/*DRUG THERAPY Leukemia, Nonlymphocytic, Acute/*DRUG THERAPY Pentamidine/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Pneumonia, Pneumocystis carinii/ETIOLOGY/*PREVENTION & CONTROL Trimethoprim-Sulfamethoxazole Combination/ADVERSE EFFECTS/ THERAPEUTIC USE ABSTRACT 940228
M9420819
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
