High prevalence of Dapsone-induced oxidant hemolysis in North American SCT recipients without glucose-6-phosphate-dehydrogenase deficiency

H. Olteanu, A. M. Harrington, B. George, P. N. Hari, C. Bredeson, S. H. Kroft

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Dapsone (4-4′-diaminodiphenylsulfone) is commonly used for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in immunocompromised patients. Oxidant hemolysis is a known complication of dapsone, but its frequency in adult patients who have undergone a SCT for hematological malignancies is not well established. We studied the presence of oxidant hemolysis, by combining examination of RBC morphology and laboratory data, in 30 patients who underwent a SCT and received dapsone for PCP prophylaxis, and compared this group with 26 patients who underwent a SCT and received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. All patients had normal glucose-6-phosphate dehydrogenase (G6PDH) enzymatic activity. In SCT patients, dapsone compared with TMP-SMX for PCP prophylaxis was associated with a high incidence of oxidant hemolysis (87 vs 0%, P<0.001), and the morphological evaluation of oxidant hemolysis correlated well with laboratory evidence of hemolysis. Dapsone-induced oxidant hemolysis in SCT patients is 20-fold higher than the reported rate in the population of HIV-infected patients, and thus much higher than the prevalence of G6PDH variants in the general population. In our patients, it manifested clinically as a lower Hb that was not significant enough to result in increased packed RBC transfusions.

Original languageEnglish (US)
Pages (from-to)399-403
Number of pages5
JournalBone Marrow Transplantation
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2012

Keywords

  • SCT
  • dapsone
  • oxidant hemolysis
  • peripheral blood morphology

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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