Critical Reviews in Oncology/Hematology 85 (2013) 373–382 Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas Filip Y. DeVos a,∗ , Johanna M. Gijtenbeek b , Chantal P. Bleeker-Rovers c , Carla M. van Herpen d a Department of Medical Oncology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands b Department of Neuro-Oncology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands c Department of Internal Medicine-Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands d Department of Medical Oncology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Accepted 2 August 2012 Contents 1. Introduction ......................................................................................................... 374 2. Search strategy ....................................................................................................... 374 3. Pneumocystis jirovecii pneumonia ..................................................................................... 374 3.1. Immunological response to PcP .................................................................................. 375 4. PcP risk factors specific for glioblastoma patients ........................................................................ 375 4.1. Glioblastoma .................................................................................................. 375 4.2. Corticosteroids ................................................................................................ 375 4.3. Radiation therapy .............................................................................................. 376 4.4. Chemotherapy ................................................................................................. 376 5. Prophylaxis for PcP .................................................................................................. 376 5.1. Agents used for PcP ............................................................................................ 377 5.1.1. TMP-SMX ............................................................................................ 377 5.1.2. Pentamidine ........................................................................................... 378 5.1.3. Dapsone .............................................................................................. 378 5.1.4. Atovaquone ........................................................................................... 378 5.1.5. Trials with multiple arms comparing different prohylaxis regimens .......................................... 378 5.2. Reducing the risk of PcP in high-grade glioma patients ............................................................ 378 6. Conclusion .......................................................................................................... 379 Conflict of interest ................................................................................................... 379 Funding source ...................................................................................................... 379 Reviewers ........................................................................................................... 379 Acknowledgements .................................................................................................. 379 References .......................................................................................................... 379 Biography ........................................................................................................... 382 Abstract High-grade glioma patients receiving concomitant chemoradiotherapy with temozolomide 75 mg/m 2 during six to seven weeks or dose- dense temozolomide regimens especially in combination with chronic use of corticosteroids have a high risk for developing Pneumocystis jirovecii pneumonia. In this review, we define risk groups and propose a guideline for prophylaxis using risk stratification. © 2012 Elsevier Ireland Ltd. All rights reserved. Keywords: Pneumocystis jirovecii; Prophylaxis; Temozolomide; High-grade glioma ∗ Corresponding author. Tel.: +31 887556265; fax: +31 887553741. E-mail address: f.devos@umcutrecht.nl (F.Y. De Vos). 1040-8428/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.critrevonc.2012.08.002