Purpose

Diffuse gliomas are managed with radiation and temozolomide; however, this therapy often results in hematologic toxicities. Patients undergoing chemoradiation also risk contracting Pneumocystis jirovecii pneumonia (PJP), and frequently receive prophylaxis against PJP during treatment. Independent of chemoradiation, some PJP prophylaxis drugs have the potential to cause myelosuppression, which could require cessation of chemotherapy. Here, we evaluate differences in the frequency of hematologic toxicities during chemoradiation when patients receive PJP prophylaxis.

Methods

This retrospective chart review evaluated patients with primary brain tumors treated with radiation and concurrent temozolomide. Analyses were performed to assess the effect of the type of PJP prophylaxis on risk for neutropenia, lymphopenia, or thrombocytopenia and the severity of these adverse effects as defined using the Common Terminology Criteria for Adverse Events.

Results

Of the 217 patients included in this analysis, 144 received trimethoprim-sulfamethoxazole (TMP/SMX) and 69 received pentamidine. Of the patients who received TMP/SMX, 15.3% developed an absolute neutrophil count < 1500 cells/µL compared with 7.2% of patients receiving pentamidine (p = 0.10). Platelet count < 100,000/µL occurred in 18.1% of patients who received TMP/SMX and 20.3% of patients who received pentamidine (p = 0.70). No significant differences in lymphocyte counts between therapies were seen. Severity of hematologic toxicities were similar between PJP prophylaxis groups.

Conclusion

These findings suggest that the type of PJP prophylaxis does not significantly affect the risk for hematologic toxicity in brain tumor patients receiving radiation and temozolomide. Additional studies are merited to evaluate the higher rate of neutropenia in patients on TMP/SMX observed in this study.

中文翻译：

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预防耶氏肺孢子虫肺炎对接受原发性脑肿瘤放化疗的患者血液学毒性的影响

目的

弥漫性神经胶质瘤可通过放疗和替莫唑胺治疗；然而，这种疗法常常导致血液学毒性。接受放化疗的患者还有感染耶氏肺孢子虫肺炎 (PJP) 的风险，并且在治疗期间经常接受针对 PJP 的预防。独立于放化疗，一些 PJP 预防药物有可能引起骨髓抑制，这可能需要停止化疗。在这里，我们评估了患者接受 PJP 预防时放化疗期间血液毒性发生频率的差异。

方法

本回顾性图表回顾评估了接受放射治疗和同时替莫唑胺治疗的原发性脑肿瘤患者。进行分析以评估 PJP 预防类型对中性粒细胞减少症、淋巴细胞减少症或血小板减少症风险的影响，以及使用不良事件通用术语标准定义的这些不良反应的严重程度。

结果

在本次分析中纳入的 217 名患者中，144 名患者接受了甲氧苄啶-磺胺甲恶唑 (TMP/SMX) 治疗，69 名患者接受了喷他脒治疗。在接受 TMP/SMX 的患者中，15.3% 的患者中性粒细胞绝对计数 < 1500 个细胞/μL，而接受喷他脒的患者为 7.2%（p  = 0.10）。接受 TMP/SMX 治疗的患者中有 18.1% 发生血小板计数 < 100,000/μL，而接受喷他脒治疗的患者则有 20.3% ( p  = 0.70)。治疗之间的淋巴细胞计数没有发现显着差异。 PJP 预防组之间的血液学毒性严重程度相似。

结论

这些发现表明，PJP 预防类型不会显着影响接受放疗和替莫唑胺的脑肿瘤患者的血液毒性风险。值得进行更多研究来评估本研究中观察到的 TMP/SMX 患者中性粒细胞减少症的较高发生率。