Dapsone safety in hematology patients: Pathways to optimizing Pneumocystis jirovecii pneumonia prophylaxis in hematology malignancy and transplant recipients

Transplant Infectious Disease : an Official Journal of the Transplantation Society
K F UrbancicJ A Trubiano

Abstract

Dapsone may be used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in hematology patients receiving immunosuppressive therapy or after hematopoietic stem cell transplant (HSCT) in the setting of trimethoprim-sulfamethoxazole (TMP-SMX) adverse drug reaction (ADR) history. Dapsone-induced hematological toxicities such as oxidative hemolysis may limit use in these patients and modern assessments of dapsone allergy cross-reactivity in non-HIV patients with a sulfonamide allergy are largely absent. The aim of this single-centre, retrospective study was to describe dapsone usage in hematology patients requiring PJP prophylaxis, including HSCT recipients, over a 12-month period in terms of indications, incidence of dapsone-attributed oxidative hemolysis, and immune cross-reactivity in those previously labeled with a sulfonamide allergy, as well as describing potential opportunities for first-line TMP-SMX PJP prophylaxis reintroduction. Of 24 patients meeting the study inclusion criteria, 12 (50%) were receiving dapsone PJP prophylaxis post-HSCT. No cases of breakthrough PJP infection were noted. Sixteen patients (67%) were initiated on dapsone to avoid the perceived risk of further myelosuppression with TMP-SMX and five patien...Continue Reading

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Citations

Oct 10, 2019·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Joseph B PryorLynne Strasfeld
Aug 6, 2019·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Alessio MesiniElio Castagnola
Dec 7, 2020·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Jessica HedvatNicholas W Lange
Jul 23, 2021·Reviews in Endocrine & Metabolic Disorders·John G RizkKamyar Kalantar-Zadeh
Jun 30, 2019·The Journal of Allergy and Clinical Immunology. in Practice·Jason A TrubianoElizabeth J Phillips

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