Pneumocystis jirovecii pneumonia associated with gemcitabine chemotherapy: experience at an Australian center and recommendations for targeted prophylaxis.
Pneumocystis jirovecii pneumonia (PJP) is seen increasingly in non-human immunodeficiency virus (HIV) infected immunocompromised populations, but few cases have previously been reported in association with gemcitabine therapy. We identified all patients administered gemcitabine between March 2009 and December 2012 at the Peter MacCallum Cancer Centre. Cases of PJP were identified using accepted definitions. Overall, 288 gemcitabine-treated patients were identified. Nine cases of PJP were detected, corresponding to an overall rate of 3.1% (95% confidence interval [CI] 1.5-5.7%). PJP was diagnosed during gemcitabine therapy in seven patients, a median of 67 (range 31-109) days from commencement. Among patients with lymphoma, 4/22 developed PJP, corresponding to a rate of 18.2% (95% CI 6.1-38.2%). Fewer infections were associated with breast, lung and gastrointestinal malignancies (1/24 [4.2%], 3/118 [2.5%] and 1/61 [1.6%], respectively). A risk-based tool incorporating concomitant steroid therapy can be applied to target high-risk populations who would benefit from PJP prophylaxis during gemcitabine therapy.
Pharmacy Department, Peter MacCallum Cancer Centre , East Melbourne , Australia.
Senthil M
SM
Lingaratnam
Monica A
MA
Slavin
Karin A
KA
Thursky
Benjamin W
BW
Teh
Gabrielle M
GM
Haeusler
John F
JF
Seymour
Danny
D
Rischin
Leon J
LJ
Worth
D000368:Aged; D019072:Antibiotic Prophylaxis; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001315:Australia; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine
Pneumocystis jirovecii; gemcitabine; guideline; pneumonia; polymerase chain reaction (PCR); prophylaxis