Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) +/- chemotherapy (CTRT): audit of the first UK departmental guideline
Beech, A. Faivre-Finn, Corinne Bayman, Neil A Blackhall, Fiona H Califano, Raffaele Chan, Clara Cobben, David Coote, Joanna H Cove-Smith, Laura Harris, Maggie A
Beech, A.
Faivre-Finn, Corinne
Bayman, Neil A
Blackhall, Fiona H
Califano, Raffaele
Chan, Clara
Cobben, David
Coote, Joanna H
Cove-Smith, Laura
Harris, Maggie A
Citations
Altmetric:
Abstract
Introduction: Lymphopenia is a known risk factor for PJP infection
and patients receiving radiation to mediastinum with/without
chemotherapy are at higher risk. The Manchester Lung Group
developed guidelines for co-trimoxazole prophylaxis to start either
on first fraction of RT in patients treated with sequential/concurrent
CTRT or when lymphocyte count (LC) <0.6 in patients treated with
RT alone (RTA). We evaluated adherence to guidelines and predictors
of lymphopenia.
Methods: Patients receiving minimum of 20 fractions of radical
lung RT were included prospectively between August/October 2018.
Weekly full blood count was introduced to monitor LC.
Results: 96 patients: 22 sequential, 15 concurrent CTRT, and 59 RTA.
3/37 patients did not receive prophylaxis in the chemo-RT group (all
sequential) and only 21/37 were prescribed it on the first day of RT. 23/59 RTA patients were prescribed prophylaxis including 13 when
LC was ≥0.6 (of which only 4 developed LC <0.6 during treatment).
For RTA patients, prophylaxis was prescribed on weeks 1, 2, 3, 4 in 7,
6, 7, 3 patients respectively. The mean reduction in absolute LC from
baseline was: 0.77, 0.84 and 0.80 for sequential/concurrent CTRT,
and RTA 0.80, respectively. Lung V20 was associated with drop in LC
in sequential CTRT group (p=0.00256) whereas PTV was correlated
with drop in LC in concurrent group (p=0.0192), although numbers
are small.
Conclusion: Some organizational issues were identified in the implementation
of this protocol and clarity needed in interpreting cut-off
for LC. Future work is required to identify clinical and RT parameters
as predictors of lymphopenia in order to individualise PJP prophylaxis.
Given the drops in LC in the 3 groups, PJP prophylaxis protocol should
be more widely considered for radical RT in lung cancer.
Authors
Beech, A.
Faivre-Finn, Corinne
Bayman, Neil A
Blackhall, Fiona H
Califano, Raffaele
Chan, Clara
Cobben, David
Coote, Joanna H
Cove-Smith, Laura
Harris, Maggie A
Hughes, Sarah
Marti-Marti, Francisca
Pemberton, Laura S
Salem, Ahmed
Taylor, Paul
Wang, Xin
Woolf, David K
Sheikh, Hamid Y
Summers, Yvonne J
Faivre-Finn, Corinne
Bayman, Neil A
Blackhall, Fiona H
Califano, Raffaele
Chan, Clara
Cobben, David
Coote, Joanna H
Cove-Smith, Laura
Harris, Maggie A
Hughes, Sarah
Marti-Marti, Francisca
Pemberton, Laura S
Salem, Ahmed
Taylor, Paul
Wang, Xin
Woolf, David K
Sheikh, Hamid Y
Summers, Yvonne J
Affiliation
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Beech A, Faivre-Finn C, Bayman NA, Blackhall FH, Califano R, Chan C, et al. Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) +/- chemotherapy (CTRT): audit of the first UK departmental guideline. Lung Cancer. 2020;139:S36-S7