# Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination

Source: https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/  
OnCo record `lymphoma-tx-pjp-and-infection-prophylaxis` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Several lymphoma treatments knock out the part of the immune system that keeps a particular lung infection, Pneumocystis, at bay. A low-dose antibiotic three times a week prevents it, and a separate tablet prevents shingles.

## Summary

Pneumocystis jirovecii pneumonia prophylaxis, usually co-trimoxazole 480 to 960 mg daily or 960 mg three times a week, is given during and after: R-CHOP and other anthracycline regimens in the elderly or with prolonged steroid exposure; any regimen containing high-dose or prolonged corticosteroid; purine analogues (fludarabine, cladribine, bendamustine); alemtuzumab; CAR-T and bispecific antibodies; idelalisib, duvelisib and copanlisib, where pneumocystis pneumonia and cytomegalovirus reactivation were the toxicities that limited the class. Alternatives for sulphonamide allergy are dapsone, atovaquone or nebulised pentamidine.

Herpes prophylaxis with aciclovir or valaciclovir is standard with bortezomib, with purine analogues, after autologous transplant and with CAR-T. Antifungal prophylaxis is not routine in lymphoma outside transplant and prolonged neutropenia.

Growth factor support. Primary G-CSF prophylaxis is given with dose-dense and intensive regimens (DA-EPOCH-R, CODOX-M/IVAC, escalated BEACOPP, BrECADD) and to patients over 65 receiving R-CHOP, where febrile neutropenia risk exceeds 20 per cent.

Vaccination. Inactivated influenza and COVID-19 vaccines are given but respond poorly during and for six to twelve months after anti-CD20 treatment; live vaccines are contraindicated. Pneumococcal, Haemophilus influenzae type b and meningococcal vaccination is given before a planned splenectomy for splenic marginal zone lymphoma, and lifelong penicillin prophylaxis follows it. Household contacts should be vaccinated.

## Fields

- Kind: Term
- Last checked: 2026-09-29
- Also known as: Pneumocystis prophylaxis; Co-trimoxazole prophylaxis; PCP prophylaxis; Aciclovir prophylaxis

## Sources

- British Society for Haematology guidelines: https://b-s-h.org.uk/guidelines/
- NCI PDQ: adult non-Hodgkin lymphoma treatment (health professional): https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq

## Connected records

- cancers: [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)](https://onco.cc/cancers/angioimmunoblastic-t-cell-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Sezary syndrome](https://onco.cc/cancers/sezary-syndrome/), [Splenic marginal zone lymphoma](https://onco.cc/cancers/splenic-marginal-zone-lymphoma/)
- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [Growth factors: G-CSF and febrile neutropenia prevention](https://onco.cc/technologies/g-csf-growth-factors/)
- drugs: [Alemtuzumab](https://onco.cc/drugs/alemtuzumab/), [Bendamustine](https://onco.cc/drugs/bendamustine/), [Bortezomib](https://onco.cc/drugs/bortezomib/), [Cladribine](https://onco.cc/drugs/cladribine/), [Copanlisib](https://onco.cc/drugs/copanlisib/), [Duvelisib](https://onco.cc/drugs/duvelisib/), [Filgrastim (G-CSF)](https://onco.cc/drugs/filgrastim/), [Fludarabine](https://onco.cc/drugs/fludarabine/), [Idelalisib](https://onco.cc/drugs/idelalisib/), [Pegfilgrastim](https://onco.cc/drugs/pegfilgrastim/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Hepatitis B reactivation before rituximab and other anti-CD20 antibodies](https://onco.cc/terms/lymphoma-tx-hepatitis-b-reactivation/), [Immunoglobulin replacement after CAR-T, bispecifics and long anti-CD20 treatment](https://onco.cc/terms/lymphoma-tx-immunoglobulin-replacement/), [Neutropenia](https://onco.cc/terms/neutropenia/)

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