title: The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: a CIBMTR analysis.
abstract: Pneumocystis jiroveci pneumonia (PJP) is associated with high morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Little is known about PJP infections after HSCT because of the rarity of disease given routine prophylaxis. We report the results of a Center for International Blood and Marrow Transplant Research study evaluating the incidence, timing, prophylaxis agents, risk factors and mortality of PJP after autologous (auto) and allogeneic (allo) HSCT. Between 1995 and 2005, 0.63% allo recipients and 0.28% auto recipients of first HSCT developed PJP. Cases occurred as early as 30 days to beyond a year after allo HSCT. A nested case cohort analysis with supplemental data (n=68 allo cases, n=111 allo controls) revealed that risk factors for PJP infection included lymphopenia and mismatch after HSCT. After allo or auto HSCT, overall survival was significantly poorer among cases vs controls (P=0.0004). After controlling for significant variables, the proportional hazards model revealed that PJP cases were 6.87 times more likely to die vs matched controls (P<0.0001). We conclude PJP infection is rare after HSCT but is associated with high mortality. Factors associated with GVHD and with poor immune reconstitution are among the risk factors for PJP and suggest that protracted prophylaxis for PJP in high-risk HSCT recipients may improve outcomes.
authors.affiliation: Children's Research Institute, Children's National Health System, Washington, DC, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
authors.forename: M D
authors.initials: MD
authors.lastname: Aljurf
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Agwu
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Chen
authors.affiliation: Division of Blood and Marrow Transplantation and Cellular Therapies, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Walsh
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Szabolcs
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeckh
authors.affiliation: Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Auletta
authors.affiliation: Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Lindemans
authors.affiliation: Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Zanis-Neto
authors.affiliation: Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Malvezzi
authors.affiliation: Cell Transplantation Program, Western Pennsylvania Cancer Institute, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lister
authors.affiliation: Paediatric Oncology, Haematology and SCT Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain.
authors.forename: J S
authors.initials: JS
authors.lastname: de Toledo Codina
authors.affiliation: Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: K
authors.initials: K
authors.lastname: Sackey
authors.affiliation: Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, OK, USA.
authors.forename: J L H
authors.initials: JL
authors.lastname: Chakrabarty
authors.affiliation: Department of Hematology, Karolinska University, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Ljungman
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: Seftel
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Seo
authors.affiliation: Department of Hematology/Oncology, All Children's Hospital, St. Petersburg, FL, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Hale
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Viracor-IBT Laboratories, Lee's Summit, MO, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Smith
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Abdel-Azim
authors.affiliation: Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Dvorak
authors.affiliation: Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Szer
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Storek
authors.affiliation: Royal Adelaide Hospital/SA Pathology and School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Yong
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Riches
mesh_terms: D064591:Allografts; D064592:Autografts; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors