Following BMT there is a 5-15% risk of
interstitial pneumonia caused by Pneumocystis carinii (PcP).
Cotrimoxazole is therefore administered prophylactically, but may cause myelodepression,
allergic reactions and nephrotoxicity. As PcP prophylaxis with
pentamidine aerosol is effective in patients with
AIDS, we conducted a prospective trial with regular inhalations of
pentamidine. The aim of this study was to evaluate toxicity, safety, practicability and possible resorption of aerosolized
pentamidine. We treated 31 allogeneic and 12 autologous BMT patients with 60 mg
pentamidine 3 days before and 14 days after BMT. Starting 4 weeks after BMT, 300 mg
pentamidine was given every 4 weeks for 6 months. There was no
pneumonia caused by Pneumocystis carinii. The only noteworthy side-effects were
cough (19.8%), salivation (9.6%), and
sore throat (5.7%), of similar frequency after allogeneic or autologous BMT. Using high pressure liquid chromatography,
pentamidine could only be detected in the serum of 33-54% of patients tested. In these patients the median serum levels were 7.5-9 ng/ml. We conclude that
pentamidine aerosol has only minor side-effects, is well tolerated and safe, and is therefore an attractive alternative for PcP prophylaxis after BMT.