Toxicity and efficacy of daily dapsone as Pneumocystis jiroveci prophylaxis after hematopoietic stem cell transplantation: A case-control study

Dario Sangiolo, Barry Storer, Richard Nash, Lawrence Corey, Chris Davis, Mary Flowers, Robert C. Hackman, Michael Boeckh

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

The toxicity and efficacy of dapsone given daily as Pneumocystis jiroveci (PCP) prophylaxis in hematopoietic stem cell transplant (HSCT) recipients who cannot take trimethoprim-sulfamethoxazole (TMP-SMX) have not been fully evaluated. We compared 155 HSCT recipients who received daily dapsone as second-line PCP prophylaxis with 310 matched control patients who received TMP-SMX throughout the posttransplantation course. Among patients who started dapsone before transplantation because of TMP-SMX allergy, there was no difference in the transfusion requirement after HSCT when compared with controls. Among patients who started dapsone after transplantation, increased red blood cell (P <.0001) and platelet transfusion (P = .003) requirements were noted compared with controls. This effect was, however, limited to patients who were receiving dapsone for reasons (mostly neutropenia) other than TMP-SMX allergy. Two of 155 patients developed PCP, compared with 0 of 310 controls (P = .11); both patients survived. In conclusion, the efficacy of daily dapsone in preventing PCP was similar to that observed in patients able to remain on TMP-SMX prophylaxis. Dapsone did not seem to cause hematologic toxicity among TMP-SMX-allergic patients. The observed higher transfusion need in patients who received dapsone for reasons other than TMP-SMX allergy seems mostly due to an underlying condition of poor marrow reserve. Further studies are required to establish whether the drug has an etiologic role in these situations.

Original languageEnglish
Pages (from-to)521-529
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume11
Issue number7
DOIs
Publication statusPublished - Jul 2005

Fingerprint

Pneumocystis carinii
Dapsone
Hematopoietic Stem Cell Transplantation
Case-Control Studies
Sulfamethoxazole Drug Combination Trimethoprim
Hematopoietic Stem Cells
Hypersensitivity
Transplants
Transplantation
Platelet Transfusion
Neutropenia
Erythrocytes
Bone Marrow

Keywords

  • Dapsone
  • Hematopoietic stem cell transplantation
  • Pneumocystis jiroveci

ASJC Scopus subject areas

  • Transplantation

Cite this

Toxicity and efficacy of daily dapsone as Pneumocystis jiroveci prophylaxis after hematopoietic stem cell transplantation : A case-control study. / Sangiolo, Dario; Storer, Barry; Nash, Richard; Corey, Lawrence; Davis, Chris; Flowers, Mary; Hackman, Robert C.; Boeckh, Michael.

In: Biology of Blood and Marrow Transplantation, Vol. 11, No. 7, 07.2005, p. 521-529.

Research output: Contribution to journalArticle

Sangiolo, Dario ; Storer, Barry ; Nash, Richard ; Corey, Lawrence ; Davis, Chris ; Flowers, Mary ; Hackman, Robert C. ; Boeckh, Michael. / Toxicity and efficacy of daily dapsone as Pneumocystis jiroveci prophylaxis after hematopoietic stem cell transplantation : A case-control study. In: Biology of Blood and Marrow Transplantation. 2005 ; Vol. 11, No. 7. pp. 521-529.
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