For six months after
bone marrow transplantation (BMT) there is a risk of 5 to 15% to suffer from
interstitial pneumonia due to pneumocystis carinii (PcP). Prophylaxis with
trimethoprim/sulfamethoxazol is therefore routinely and successfully applied. However myelotoxicity,
allergic reactions, augmentation of the risk of nephrotoxicity with
cyclosporine A and noncompliance may be serious problems. Since the prophylaxis of PcP with
pentamidine-
aerosol proved to be effective in patients with
AIDS, we conducted a prospective trial with regular inhalations of
pentamidine. The aim of this study was to evaluate the toxicity, safety, practicability and possible resorption of
pentamidine when applied as
aerosol. The first of 43 patients were treated with 60 mg
pentamidine on two days before, at the day of BMT and 14 days after BMT. Starting four weeks after BMT, 300 mg
pentamidine were given every four weeks up to six months. After the study, the four 60 mg inhalations were replaced by two 300 mg inhalations before BMT, because this proved to be more convenient for the patients. There was no
pneumonia due to pneumocystis carinii. The only noteworthy side effects observed were
cough (19.8%), salivation (9.6%) and
sore throat (5.7%). In general
pentamidine was well tolerated and well accepted by the patients.
Pentamidine could only be detected in the serum of 40 to 60% of all patients. In those patients the serum levels were 7.5 to 9 ng/ml and similar to concentrations found in comparable patients with
AIDS. 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.