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Antimicrobial prophylaxis in patients with immune thrombocytopenia treated with rituximab: a retrospective multicenter analysis

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Abstract

The primary aim of this study was to describe the use of primary anti-infective prophylaxis (AP) in common clinical practice in patients affected by immune thrombocytopenia (ITP) and treated with RTX. Population studied consisted of patients affected by ITP (age ≥ 18 years) who had received at least one dose of RTX from January 2008 to June 2018. Five Italian haematology centres participated in the current study. Data were retrospectively collected: demographic data (age, gender), concomitant comorbidities and previous therapies for ITP, characteristics of AP, the occurrence of infections and their management. The ITP cohort consisted of 67 patients sub-grouped into two categories according to the administration of AP: (1) treated with AP (N= 34; 51%) and (2) not treated with AP (N=33, 49%). AP consisted of combined trimethoprim/sulfamethoxazole (TMP/SMX) and acyclovir (AC) in half of patients. TPM/SMX as a single agent was adopted in 32% patients and one patient received only AC. Overall, infections were experienced in 15% of patients during follow-up with a similar proportion in the 2 groups (treated and not treated) of patients (14.7% vs 15%). Clinical course of infections was however, less severe in patients treated with AP, where all infections were grade 2 and did not require hospitalization. In neither group of patients was reported Pneumocystis pneumonia. In conclusion, despite the absence of clear evidence, our analysis shows that AP in patients with ITP receiving RTX is frequently adopted, even if in the absence of well-defined criteria. Prophylaxis administration is quite consistent within the same haematological Center; thus, it seems related to clinicians’ experience.

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Data availability

All data related to this study are available on request.

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Acknowledgments

Authors are grateful to Elsevier Editing Service for language editing of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Author notes

  1. Simona Raso and Mariasanta Napolitano contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy

    Simona Raso & Marco Santoro

  2. Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy

    Mariasanta Napolitano, Giulia Arrigo, Marco Santoro, Vincenzo Accurso & Sergio Siragusa

  3. Institute for Educational Technology, National Research Council of Italy, Palermo, Italy

    Francesco Reale

  4. Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Alessandro Lucchesi

  5. Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Paolo Silimbani

  6. Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy

    Aurelio Maggio & Giuseppina Calvaruso

  7. Unit of Haematology, G.Garibaldi Hospital, Catania, Italy

    Ugo Consoli

  8. Unit of Haematology, Azienda Ospedaliera Papardo, Messina, Italy

    Donato Mannina

  9. Division of Internal Medicine, Hematology Service, Regional Hospital “A. Cardarelli”, Campobasso, Italy

    Giulio Giordano

Authors
  1. Simona Raso
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  2. Mariasanta Napolitano
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  3. Giulia Arrigo
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Contributions

SR analysed and interpreted the data and wrote the article. MN analysed and interpreted data and wrote the article. GA collected and curated the data. FRe performed the statistical analysis. PS collected the data. AL collected the data. GCo collected the data. UCi collected the data. GG curated the data. AM collected the data. MS collected the data. VA collected the data. SS reviewed the manuscript and provided editorial input.

Corresponding author

Correspondence to Simona Raso.

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Conflict of interest

MN acted as consultant for Bayer, BIOFVIIIx, Novonordisk and Amgen and received speaker fees from Kedrion, Octapharma, Baxalta, CSLBehring, Novonordisk, Bayer and Sobi.Takeda. SS acted as the consultant for Bayer, Novonordisk, Amgen, Biomarin and Novartis and received speaker fees from Baxalta, CSLBehring, Novonordisk, Bayer, Sobi.Takeda and BioFVIIIx. All other authors have no relevant conflicts of interest to declare.

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The study was approved by the local Ethics Committee and was conducted in accordance with the Declaration of Helsinki.

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Raso, S., Napolitano, M., Arrigo, G. et al. Antimicrobial prophylaxis in patients with immune thrombocytopenia treated with rituximab: a retrospective multicenter analysis. Ann Hematol 100, 653–659 (2021). https://doi.org/10.1007/s00277-021-04438-7

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  • DOI: https://doi.org/10.1007/s00277-021-04438-7

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