From the Guidelines
Septran DS (sulfamethoxazole-trimethoprim) should be used as prophylaxis against Pneumocystis jirovecii pneumonia (PJP) in multiple myeloma patients who are immunocompromised due to their disease or treatments, as it has been shown to reduce the incidence of PJP by 91% in a meta-analysis of studies in transplant recipients and haematological malignancy 1.
Key Points to Consider
- Multiple myeloma is a cancer of plasma cells that requires specific anti-cancer therapies, and Septran DS is not typically used as a primary treatment for this condition.
- However, Septran DS has an important supportive role in multiple myeloma patients as prophylaxis against PJP, particularly during high-dose chemotherapy, stem cell transplantation, or when patients are on regimens containing high-dose steroids.
- The typical prophylactic dose is one double-strength tablet (800mg sulfamethoxazole/160mg trimethoprim) three times weekly, often on Monday, Wednesday, and Friday.
- Patients should be monitored for potential side effects including rash, cytopenias, and kidney function abnormalities.
- For patients with sulfa allergies, alternative prophylaxis options like dapsone, atovaquone, or inhaled pentamidine should be considered.
Evidence-Based Recommendations
- A study from the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults found that PJP prophylaxis using co-trimoxazole reduced the incidence of PJP by 91% in a meta-analysis of studies in transplant recipients and haematological malignancy 1.
- The European Myeloma Network guidelines for the management of multiple myeloma-related complications recommend routine antibiotic prophylaxis for the first three months of therapy with immunomodulatory drugs (IMiDs) such as lenalidomide and pomalidomide, particularly for patients with aggressive disease, history of infectious complications or neutropenia 1.
From the Research
Septran DS in Multiple Myeloma
- Septran DS, also known as trimethoprim-sulfamethoxazole (TMP-SMX), is used as a prophylactic antibiotic in patients with multiple myeloma to prevent early infection 2.
- The study found that administering TMP-SMX for the first 2 months of initial chemotherapy is effective in preventing early bacterial infection in multiple myeloma, with a significant reduction in the rate of bacterial infection (2.43 per patient-year for controls vs 0.29 per patient-year for the TMP-SMX group) 2.
- However, toxicity, including skin rash and nausea, was reported in some patients, requiring discontinuation of TMP-SMX in 25% of patients 2.
- Other studies have also shown that TMP-SMX is effective in preventing Pneumocystis jirovecii pneumonia (PCP) in patients with connective tissue diseases and hematological malignancies, including multiple myeloma 3, 4.
- Alternative prophylactic agents, such as pentamidine and atovaquone, may be used in patients who are intolerant to TMP-SMX or have a history of sulfonamide allergy 3, 5.
- The diagnosis and management of multiple myeloma involve a combination of laboratory tests, imaging studies, and treatment with proteasome inhibitors, immunomodulatory agents, and corticosteroids, with autologous hematopoietic stem cell transplantation and maintenance therapy with lenalidomide considered standard care for eligible patients 6.