PROPHYLAXIS OF TOXOPLASMOSIS INFECTION WITH PYRIMETHAMINE SULFADOXINE(FANSIDAR) IN BONE-MARROW TRANSPLANT RECIPIENTS/

Prophylaxis against toxoplasmosis with weekly administration of pyrime thamine/sulfadoxine (Fansidar) was assessed for efficacy and toxicity in bone marrow transplant (BMT) recipients over a 21 month period. Six ty-nine of 90 consecutive seropositive patients were evaluable. Fansid ar was administered from the time of established engraftment (median d ay 40, range days 13-100). Medication was scheduled to be continued un til 6 months or longer in cases of continued immunosuppression (median 10 months, range day 72 to 22 months). No proven case of toxoplasmosi s occurred in patients receiving prophylaxis. In addition, there were no cases of Pneumocystis carinii. Side-effects included BM suppression requiring cessation (n = 4) or interruption (n = 8) of therapy and ra sh (n = 1). To evaluate toxicity associated with prolonged therapy, 42 evaluable patients were assessed at 6 months following transplant (or at least 4 months of continuous treatment). Haematological toxicity w as minimal and compounded in three patients showing moderate derangeme nt by cytomegalovirus infection and graft-versus-host disease. Fansida r is an effective prophylactic agent against toxoplasmosis in BMT pati ents.