Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation: a 6-year retrospective study.
Pneumocystis jiroveci pneumonia (PCP) has become a rare opportunistic infection due to the efficacy of prophylactic regimens. We conducted a 6-year retrospective study at our institution. A total of 13 cases of PCP were diagnosed among 519 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (2.5%). In three patients, PCP occurred within the first 5 months following HSCT. These severely immunocompromised patients were receiving prophylaxis and had concomitant aspergillosis that caused rapid death in two of them. In 10 other patients, PCP occurred a median of 14.5 months after HSCT. In all these patients, PCP prophylaxis had been discontinued, mainly because of the suspected bone-marrow toxicity of the prophylactic regimen. Median CD4+ T cell count was 131/microl at diagnosis. Seven of these 10 patients were receiving immunosuppressive therapy for chronic graft versus host disease and three had a relapse of their hematological malignancy. One patient died from PCP despite high doses of cotrimoxazole. We conclude that PCP is still occurring after allogeneic HSCT, mainly as a late complication in patients in whom PCP prophylaxis had been prematurely discontinued. Long-term PCP prophylaxis should be maintained in patients receiving immunosuppressive drugs, and in those with low CD4+ T cell counts or a relapse of their hematological malignancy.
De Castro
N
N
Department of Infectious Diseases, Saint-Louis Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France. nathalie.de-castro@sls.ap-hop-paris.fr
Neuville
S
S
Sarfati
C
C
Ribaud
P
P
Derouin
F
F
Gluckman
E
E
Socié
G
G
Molina
J M
JM
D018791:CD4 Lymphocyte Count; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D009894:Opportunistic Infections / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control; D011020:Pneumonia, Pneumocystis / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D011292:Premedication; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination