title: Quantification of the effect of chemotherapy and steroids on risk of Pneumocystis jiroveci among hospitalized patients with adult T-cell leukaemia.
abstract: This study aimed to quantify the risks of Pneumocystis pneumonia (PCP) among adult T-cell leukaemia (ATL) patients without prophylaxis. We used hospital administrative data collected nationwide in Japan over 4 years. The research design was a retrospective cohort study. Subjects were 4369 patients diagnosed with ATL aged 18 years or older. The subjects were categorized into four treatment groups: no agent, chemotherapy, chemotherapy + steroids and steroids. We described the risks of PCP among ATL patients without prophylaxis. Risks of PCP were 3·2% for the no agent group, 9·7% for the chemotherapy group, 10·0% for the chemotherapy + steroids group and 16·6% for the steroids group. Logistic regression analyses showed that the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risk of PCP than did the no agent group [adjusted odds ratio (AOR) 3·30 (1·55-7·02), P = 0·002 for the chemotherapy group; AOR 3·35 (2·18-5·17), P < 0·001 for the chemotherapy + steroids group; AOR 6·12 (3·99-9·38), P < 0·001 for the steroids group]. In conclusion, the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risks of PCP. Prophylaxis for PCP among ATL patients being treated with chemotherapy, chemotherapy + steroids and steroids is highly recommended.
authors.affiliation: Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Maeda
authors.forename: Akira
authors.initials: A
authors.lastname: Babazono
authors.forename: Takumi
authors.initials: T
authors.lastname: Nishi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010419:Pentamidine / Q000627:therapeutic use; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Pneumocystis pneumonia; adult T cell leukaemia; chemotherapy; prophylaxis; steroid