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Title: Dapsone safety in haematology patients: pathways to optimising Pneumocystis jirovecii pneumonia prophylaxis in haematology malignancy and transplant recipients.
Austin Authors: Urbancic, Karen F ;Pisasale, D ;Wight, Joel C ;Trubiano, Jason A 
Affiliation: Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
National Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia
Department of Medicine, University of Melbourne, Parkville, VIC, Australia
Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 21-Jul-2018 2018-07-21
Publication information: Transplant infectious disease : an official journal of the Transplantation Society 2018: e12968
Abstract: Dapsone may be used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in haematology 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 haematological toxicities such as oxidative haemolysis may limit use in these patients and modern assessments of dapsone allergy cross-reactivity in non-HIV patients with a sulphonamide allergy are largely absent. The aim of this single-centre, retrospective study was to describe dapsone usage in haematology patients requiring PJP prophylaxis, including HSCT recipients, over a 12-month period in terms of indications, incidence of dapsone-attributed oxidative haemolysis, and immune cross-reactivity in those previously labelled with a sulphonamide allergy, as well as describing potential opportunities for first-line TMP-SMX PJP prophylaxis reintroduction. Out 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 5 patients (21%) due to prior delayed immune-mediated allergy to TMP-SMX. None experienced rash with dapsone therapy. Six patients (25%) were successfully rechallenged on TMP-SMX, including one patient with prior TMP-SMX-associated rash. Four (17%) patients had confirmed oxidative haemolysis, all resulting in dapsone cessation. Dapsone PJP prophylaxis in haematology patients was effective and safe, with non-life threatening dapsone-related haemolysis noted in a small number. An absence of sulphonamide allergy cross-reactivity was noted, suggesting greater TMP-SMX rechallenges or desensitisation could be considered in those receiving dapsone. This article is protected by copyright. All rights reserved.
DOI: 10.1111/tid.12968
ORCID: 0000-0002-5111-6367
PubMed URL: 30030892
Type: Journal Article
Subjects: Pneumocystis jirovecii pneumonia
adverse drug reactions
haematopoietic stem cell transplantation
Appears in Collections:Journal articles

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