Điều trị kháng sinh phòng ngừa bằng TMP-SMX làm giảm tỷ lệ viêm phổi kẽ ở bệnh nhân lymphoma tế bào B đang hóa trị liệu
Tóm tắt
Nhiều nghiên cứu đã báo cáo tỉ lệ viêm phổi kẽ (IP) ở bệnh nhân mắc lymphoma không Hodgkin (NHL) đang điều trị hóa chất kết hợp với rituximab; tuy nhiên, phương pháp phòng ngừa hiệu quả cho IP vẫn chưa được làm rõ. Nghiên cứu này nhằm khám phá hiệu quả phòng ngừa của trimethoprim-sulfamethoxazole (TMP-SMX) đối với IP và xác định các yếu tố nguy cơ liên quan đến IP ở bệnh nhân NHL.
Giữa tháng 3 năm 2013 và tháng 4 năm 2018, 498 bệnh nhân (264 nam, 53%) mắc NHL tế bào B đang điều trị hóa chất RCHOP-like đầu tay với rituximab kết hợp cyclophosphamide, doxorubicin, vincristine, và prednisone đã được tuyển vào nghiên cứu này.
Các bệnh nhân này có độ tuổi trung bình là 56 tuổi, và 311 trong số 498 bệnh nhân (62.4%) đã được sử dụng điều trị phòng ngừa TMP-SMX với tần suất một lần mỗi ngày. IP xảy ra ở 65 bệnh nhân (13.1%), cho thấy sự giảm đáng kể trong tỷ lệ mắc IP (21.4% so với 8.0%;
Nghiên cứu này tiết lộ rằng sự xuất hiện của IP là phổ biến ở bệnh nhân NHL tế bào B đang hóa trị kết hợp với rituximab. IP có thể được giảm với điều trị phòng ngừa TMP-SMX uống một lần mỗi ngày.
Từ khóa
Tài liệu tham khảo
Hainsworth JD, Burris HA, Morrissey LH, et al. Rituximab monoclonal antibody as initial systemic therapy for patients with low-grade non-Hodgkin lymphoma. Blood. 2000;95(10):3052–6.
Bertrand C, Eric L, Josette B, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235.
Pfreundschuh M, Trümper L, Österborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera international trial (MInT) group. Lancet Oncol. 2006;7(5):379–91.
Xin L, Xiao-Nan H, Ya-Jia G, Bi-Yun W, Zhi-Guo L, Junning C. Interstitial pneumonitis during rituximab-containing chemotherapy for non-Hodgkin lymphoma. Leuk Lymphoma. 2008;49(9):1778–83.
Arne K, Harald H, Alexander F, Grete Fossum L, Peter G, Dag T. Pneumocystis jirovecii pneumonia in B-cell lymphoma patients treated with the rituximab-CHOEP-14 regimen. Haematologica. 2007;92(1):139–40.
Sarah K, Shaun OC, Newton L, Robin F, Harshal N, Tam CS. High incidence of Pneumocystis jirovecii pneumonia in patients receiving biweekly rituximab and cyclophosphamide, adriamycin, vincristine, and prednisone. Leuk Lymphoma. 2010;51(5):797–801.
Giselle S, Michael L, Vithika S, et al. Incidence of pneumonitis in patients with non-Hodgkin lymphoma receiving chemoimmunotherapy with rituximab. Leuk Lymphoma. 2015;56(6):1659–64.
Bradley B, Branley HM, Egan JJ, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and new Zealand and the Irish thoracic society. Thorax. 2008;63(Suppl 5):v1–58.
Liu WP, Wang XP, Zheng W, et al. Incidence, clinical characteristics, and outcome of interstitial pneumonia in patients with lymphoma. Ann Hematol. 2017;8(3):1–7.
Lin PC, Hsiao LT, Poh SB, et al. Higher fungal infection rate in elderly patients (more than 80 years old) suffering from diffuse large B cell lymphoma and treated with rituximab plus CHOP. Ann Hematol. 2007;86(2):95–100.
Daisuke E, Yasuhito T, Masahiro Y, et al. Increased incidence of interstitial pneumonia by CHOP combined with rituximab. Int J Hematol. 2008;87(4):393–7.
Diebold J. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the clinical advisory committee meeting-Airlie house, Virginia, November 1997. J Clin Oncol. 1999;17(12):3835.
Katsuya H, Suzumiya J, Sasaki H, et al. Addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy has a high risk of developing interstitial pneumonia in patients with non-Hodgkin lymphoma. Leuk Lymphoma. 2009;50(11):1818–23.
Wang Q, Zhu YF, Jia RF, Jiang L, Yang XY, Oncology DO. The risk factors and clinical features of interstitial pneumonia in B-cell non-Hodgkin's lymphoma patients who were treated with rituximab-CHOP regimen. China Oncol. 2014,24(12):936–43.
Toshiro K, Hiroyasu K, Takashi Y. Two cases of Pneumocystis jiroveci pneumonia with non-Hodgkin's lymphoma after CHOP-based chemotherapy containing rituximab. J Clin Exp Hematop. 2010;50(2):159–62.
Lim KH, Yoon HI, Kang YA, et al. Severe pulmonary adverse effects in lymphoma patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen plus rituximab. Korean J Intern Med. 2010;25(1):86–92.
Huang YC, Liu CJ, Liu CY, et al. Low absolute lymphocyte count and addition of rituximab confer high risk for interstitial pneumonia in patients with diffuse large B-cell lymphoma. Ann Hematol. 2011;90(10):1145.
Kolk LE, Der V, Grillo-López AJ, Baars JW, Hack CE, Oers MH. Van. Complement activation plays a key role in the side-effects of rituximab treatment. Br J Haematol. 2015;115(4):807–11.
Berezowska S, Pöllinger A. Interstitial pneumonias--Histopathological and radiological correlation. Ther Umsch. 2016;73(1):11.
Wagner SA, Mehta AC, Laber DA. Rituximab-induced interstitial lung disease. Am J Hematol. 2010;82(10):916–9.
Mofenson LM, Oleske J, Serchuck L, Dyke RV, Wilfert C. Treating Opportunistic Infections among HIV-Exposed and Infected Children: Recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. Clin Infect Dis. 2005;40(Suppl 1):S1.
Herishanu Y, Polliack A, Leider-Trejo L, Grieff Y, Metser U, Naparstek E. Fatal interstitial pneumonitis related to rituximab-containing regimen. Clin Lymphoma Myeloma. 2006;6(5):407–9.
Hefziba G, Mical P, Liat V, Leonard L. Prophylaxis of Pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007;82(9):1052–9.
Bozzette SA, Finkelstein DM, Spector SA, et al. A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group. N Engl J Med. 1995;332(11):693.
Bucher HC, Griffith L, Guyatt GH, Opravil M. Meta-analysis of prophylactic treatments against Pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;15(2):104–14.
Hughes WT, Kuhn S, ., Chaudhary S, ., et al. Successful chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 1977;297(26):1419–1426.
Hughes WT, Rivera GK, Schell MJ, Thornton D, ., Lott L, . Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 1987;316(26):1627–1632.
Lindemulder S, Albano E. Successful intermittent prophylaxis with trimethoprim/sulfamethoxazole 2 days per week for Pneumocystis carinii (jiroveci) pneumonia in pediatric oncology patients. Pediatrics. 2007;120(1):e47–51.
Halaas JL, Moskowitz CH, Steven H, et al. R-CHOP-14 in patients with diffuse large B-cell lymphoma: feasibility and preliminary efficacy. Leuk Lymphoma. 2009;46(4):541–7.
Isidori A, Merli F, Angrilli F, Ferrara F, Alesiani F, Visani G. The incidence of pneumonia is not higher in patients receiving dose-dense therapy with rituximab, cyclophosphamide, non-pegylated liposomal doxorubicin, vincristine, and prednisolone and adequate pneumonia prophylaxis; 2011.
Hardak E, Oren I, Dann EJ, et al. The increased risk for pneumocystis pneumonia in patients receiving rituximab-CHOP-14 can be prevented by the administration of trimethoprim/sulfamethoxazole: a single-center experience. Acta Haematol. 2012;127(2):110–4.
Muñoz P, Muñoz RM, Palomo J, Rodríguez-Creixéms M, Muñoz R, Bouza E. Pneumocystis carinii infection in heart transplant recipients. Efficacy of a weekend prophylaxis schedule. Medicine. 1997;76(6):415–22.
Souza JP, Boeckh M, Gooley TA, Flowers MED, Crawford SW. High rates of Pneumocystis carinii pneumonia in allogeneic blood and marrow transplant recipients receiving Dapsone prophylaxis. Clin Infect Dis. 1999;29(6):1467–71.
Ioannidis JP, Cappelleri JC, Skolnik PR, Lau J, Sacks HS. A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Arch Intern Med. 1996;156(2):177–88.
Ya-Juan LU, Guan FQ, Wang S, Zhou W, Hospital BC. Clinical analysis of 108 cases of interstitial pneumonia in elderly with diabetes. Diabetes New World. 2015(22):107–9.
Alexandrescu DT, Dutcher JP, Kevin OB, Mehmet A, Stanley O, Wiernik PH. Fatal intra-alveolar hemorrhage after rituximab in a patient with non-Hodgkin lymphoma. Leuk Lymphoma. 2015;45(11):5.
Brusamolino E, Rusconi C, Montalbetti L, et al. Dose-dense R-CHOP-14 supported by pegfilgrastim in patients with diffuse large B-cell lymphoma: a phase II study of feasibility and toxicity. Haematologica. 2006;91(4):496–502.