Abstract
Rituximab is associated with a higher incidence of Pneumocystis jirovecii pneumonia infection. Pneumocystis prophylaxis is advised in many immunocompromised populations treated with rituximab. However, the beneficial effect of pneumocystis prophylaxis in HIV-uninfected, rituximab-treated non-Hodgkin lymphoma (NHL) patients has not been assessed. Thus, we conducted this retrospective study to explore pneumocystis infection in HIV-uninfected NHL patients who received at least three courses of chemotherapy without haematopoietic stem cell transplantation using the Taiwan National Health Insurance Research Database. Patients who had rituximab-based chemotherapy were included in the experimental (rituximab) group, while the rest of the patients who did not receive any rituximab-based chemotherapy throughout the study period formed the control group. The prevalence rate of pneumocystis infection in the rituximab group (N = 7,554) was significantly higher than that in the control group (N = 4,604) (2.95% vs. 1.32%). The onset of pneumocystis infection occurred between 6 and 16 weeks after chemotherapy. Patients who had pneumocystis prophylaxis, whether or not they had a pneumocystis infection later in their treatment course, had significantly better first-year survival rates (73% vs. 38%). Regular pneumocystis prophylaxis should be considered in this group of patients.
Highlights
Pneumocystis jiroveci pneumonia, formerly known as Pneumocystis carinii pneumonia (PcP), occurs when immune function is suppressed to a certain threshold
When rituximab is administered for various diseases, regular pneumocystis prophylaxis with trimethoprim/ sulfamethoxazole (TMP/SMX) is widely recommended by many treatment guidelines, such as Wegener’s granulomatosis and organ or haematopoietic transplant[15,16]
After excluding patients who were ineligible for this study, we found 7554 HIV-uninfected non-Hodgkin lymphoma (NHL) patients who received rituximab-based chemotherapy and 4604 HIV-uninfected NHL patients received chemotherapy without rituximab
Summary
Pneumocystis jiroveci pneumonia, formerly known as Pneumocystis carinii pneumonia (PcP), occurs when immune function is suppressed to a certain threshold Once these immunocompromised patients are infected, the mortality rate can be as high as 30 ~ 60%1,2. Rituximab is a monoclonal antibody that binds to the CD20 antigens on B lymphocytes and leads to B cell elimination from the body. Rituximab can cause prolonged hypogammaglobulinemia and hinder naive B lymphocyte differentiation into plasma cells, which are crucial for eliminating Pneumocystis jirovecii[6,9]. Together, these studies showed convincingly that the integrity of B cell function is critical for immune reactions against pneumocystis infection. The results of this study will provide further evidence to clarify if pneumocystis prophylaxis is beneficial to HIV-uninfected, rituximab-treated NHL patients
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