High risk - prophylaxis is recommended |
|
Allogeneic haematopoietic stem cell transplant (HSCT) |
From engraftment, for at least 6 months post-transplant and while immunosuppressive treatment is ongoing. |
|
Acute lymphoblastic leukaemia (ALL) |
From induction until the end of maintenance treatment. |
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Alemtuzumab |
From engraftment, for at least 6 months post-transplant and while immunosuppressive treatment is ongoing. |
|
Moderate to severe graft versus host disease (GVHD) |
Continue while immunosuppressive treatment is ongoing. |
|
Purine analogue therapy e.g.: fludarabine, cladribine and other T cell-depleting agents |
Continue for at least 6 months after completion of treatment or until CD4 count is greater than 200 cells/mcL. |
|
High-dose methotrexate (>1500 mg/m2/24 hours) |
From induction until the end of maintenance treatment.rrr |
|
Anticipated neutropenia period is greater than 10 daysr |
Continue until recovery from neutropenia. |
|
Phosphatidylinositol-3‐kinase (PI3K) inhibitors e.g. idelalisib (+/- rituximab) |
Throughout active treatment and continue until recovery from cytopenias. |
|
Prolonged corticosteroids e.g.: >/= 20 mg prednisolone daily for 4 or more weeks |
Throughout active treatment. |
|
Temozolomide + radiation therapy |
Throughout active treatment and continue until recovery from cytopenias.rrrr |
|
CD-19 targeted CAR T-cell therapies e.g. tisagenlecleucel (Kymriah®), axicabtagene ciloleucel (Yescarta®) |
From the start of lymphodepleting treatment and continue for at least 6 months; until recovery from cytopenias.
Prophylaxis is recommended in B-cell ALL (acute lymphoblastic leukaemia).
Prophylaxis in lymphoma will depend on risk factors for PJP.
|
Intermediate risk - consider prophylaxis |
|
Autologous haematopoietic stem cell transplant (HSCT) |
From engraftment, for 3 to 6 months post-transplant. |
|
Anticipated neutropenia period is 7 to 10 days |
Continue until recovery from neutropenia. |
|
Lymphoma; Multiple Myeloma (MM); Chronic Lymphocytic Leukaemia (CLL). |
Heterogenous diseases: treatment modalities and type of malignancy affect risk level.
Consider prophylaxis during neutropenia.
|
|
Ubiquitin-proteasome pathway inhibitors e.g. bortezomib, carfilzomib, ixazomib |
Consider prophylaxis for selected multiple myeloma patients with additional risk factors (i.e. prolonged high-dose steroid therapy). |
|
Bruton tyrosine kinase (BTK) inhibitors e.g. acalabrutinib, ibrutinib, zanubrutinib |
Consider prophylaxis depending on additional risk factors (see risk factors above).
|
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BCR-ABL tyrosine kinase inhibitors e.g. dasatinib, imatinib, nilotinib, ponatinib |
|
mTOR (mammalian target of rapamycin) inhibitors (e.g. everolimus, sirolimus, temsirolimus) |
|
Janus kinase (JAK) inhibitors e.g. ruxolitinib |
|
Monoclonal antibodies:
CD-targeted therapies e.g. blinatumomab, obinutuzumab, rituximab, brentuximab, daratumumab
C5 inhibitors e.g. eculizumab, ravulizumab
VEGF inhibitors e.g. bevacizumab, ramucirumab
EGFR / HER-1 inhibitors e.g. cetuximab, panitumumab
|
Consider prophylaxis depending on additional risk factors (see risk factors above).
|
|
Monoclonal antibodies:
Checkpoint inhibitors such as CTLA-4, PD-1, PD-L1 inhibitors e.g.: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab
|
No clear increased infection risk from drug, but the drug can lead to immune up-regulation which can necessitate steroids.
Consider prophylaxis if high-dose steroids are used (>/= 20 mg prednisolone daily for 4 or more weeks).
|
|
Checkpoint inhibitors in combination with anticancer agents |
Consider prophylaxis depending on additional risk factors (see risk factors above). |
Low risk - no prophylaxis required |
|
Standard chemotherapy regimens for most solid tumours |
No clear increased risk of infection.
Prophylaxis is generally not required.
|
|
Anticipated neutropenia period is less than 7 days |
|
BRAF kinase inhibitors e.g. dabrafenib, vemurafenib |
|
MEK (mitogen-activated protein kinase) kinase inhibitors e.g. cobimetinib, trametinib |
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Isocitrate dehydrogenase 1 (IDH1) inhibitors e.g. enasidenib |
|
Bcl-2 (B-cell lymphoma 2) inhibitors e.g. venetoclax |
|
FLT3 (fms-like tyrosine kinase 3) inhibitors e.g. gilteritinib |
|
Multi-target protein kinase inhibitors e.g. sorafenib |