trimethoprim--sulfamethoxazole-drug-combination and fludarabine

Guidelines for primary Pneumocystis jirovecii pneumonia (PCP) prophylaxis for patients with hematologic malignancy (HM) are still lacking. Our objective was to identify risk factors for PCP among patients with HM to help recognize patients who would benefit from primary PCP prophylaxis.. We performed a case-control study of adult patients with HM and negative for human immunodeficiency virus and with confirmed PCP by using cytology or histopathology from 2 medical centers over an 11-year period. Each case was matched with 4 patients without PCP by type of HM and year of treatment. We compared demographic, clinical, and laboratory data among cases and controls. Data were analyzed by using SPSS version 18.0.. Fourteen cases and 56 controls were included in the study period. No significant differences were seen in demographics between both groups. All identified patients had lymphoproliferative HM, the majority of patients (93%) had either non-Hodgkin lymphoma or chronic lymphocytic leukemia. Autoimmune diseases were more frequent in cases vs. controls (28.6% vs. 5.4% P = .01). The receipt and duration of chemotherapy were similar in both groups. Among chemotherapeutic agents, including steroids, only fludarabine was associated with increased risk for PCP (50% vs. 17.9%; P = .02). No difference was found in total or lymphocyte percentage in cases at the time of PCP diagnosis vs. nadir values in controls.. Patients with lymphoproliferative HM, specifically chronic lymphocytic leukemia and non-Hodgkin lymphoma, who are receiving fludarabine and with autoimmune disorders are at increased risk for PCP and should be considered for PCP primary prophylaxis.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents; Case-Control Studies; Cladribine; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Non-Hodgkin; Lymphoproliferative Disorders; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine

Drug-induced immune haemolytic anaemia is a rare but serious condition. This study investigated the possibility of drug aetiology of immune haemolytic anaemia (IHA) in 134 patients with new onset of IHA who were identified in the Berlin Case-Control Surveillance Study between 2000 and 2009. Single drugs related to IHA in three or more patients and assessed more than once as a certain or probable cause of IHA in a standardized causality assessment included diclofenac, fludarabine, oxaliplatin, ceftriaxone and piperacillin. In a case-control study including all 124 IHA cases developed in outpatient care and 731 controls, significantly increased odds ratios (OR) were observed for beta-lactam antibiotics (OR=8·8; 95% confidence interval [CI] 3·2-25·2), cotrimoxazole (OR=6·5; CI 1·1-37·9), ciprofloxacin (OR=6·9, CI 1·3-38·5), fludarabine (OR=22·2; CI: 2·8-454·5) and lorazepam (OR=5·3; CI: 1·2-21·2). Excluding new onset cases with a chronic IHA disease course, an increased risk became also apparent for diclofenac with an OR of 3·1 (CI 1·3-7·0). This is the first case-control study investigating drugs as risk factors for IHA. It corroborates an increased risk for several drugs that have been implicated as a cause of IHA in the standardized causality assessment of individual cases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents; Berlin; beta-Lactams; Case-Control Studies; Ciprofloxacin; Diclofenac; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Lorazepam; Male; Middle Aged; Odds Ratio; Piperacillin; Population Surveillance; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine; Young Adult

Early bone marrow transplant is now standard treatment for infants with severe immunodeficiencies such as Wiskott-Aldrich Syndrome (WAS), but results in older children and adults are poor. Non-myeloablative transplant has shown promise in the treatment of older children, who are likely to have active infections and organ damage. We describe a non-myeloablative transplant of a 26-year-old man with WAS, undertaken because of severe infections and vasculitis. Partial engraftment and immunorestoration were achieved. The patient is well 1 year post transplantation.

Topics: Adult; Alemtuzumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm; Bone Marrow Transplantation; Cyclophosphamide; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Male; Penicillin V; Transplantation Chimera; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine; Wiskott-Aldrich Syndrome

Topics: Aged; Antineoplastic Agents; Brain Abscess; Cefotaxime; Drug Therapy, Combination; Gentamicins; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Listeriosis; Male; Prednisone; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine