Format

Send to

Choose Destination
Bone Marrow Transplant. 2016 Apr;51(4):573-80. doi: 10.1038/bmt.2015.316. Epub 2016 Jan 4.

The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: a CIBMTR analysis.

Author information

1
Children's Research Institute, Children's National Health System, Washington, DC, USA.
2
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
3
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
4
Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
5
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
6
Division of Blood and Marrow Transplantation and Cellular Therapies, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
7
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
8
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
9
Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.
10
Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
11
Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil.
12
Cell Transplantation Program, Western Pennsylvania Cancer Institute, Pittsburgh, PA, USA.
13
Paediatric Oncology, Haematology and SCT Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain.
14
Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
15
Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, OK, USA.
16
Department of Hematology, Karolinska University, Stockholm, Sweden.
17
Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.
18
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
19
Department of Hematology/Oncology, All Children's Hospital, St. Petersburg, FL, USA.
20
Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
21
Viracor-IBT Laboratories, Lee's Summit, MO, USA.
22
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
23
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
24
Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
25
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
26
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.
27
Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA, USA.
28
Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia.
29
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
30
Royal Adelaide Hospital/SA Pathology and School of Medicine, University of Adelaide, Adelaide, Australia.
31
Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.

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.

PMID:
26726945
PMCID:
PMC4823157
DOI:
10.1038/bmt.2015.316
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Nature Publishing Group Icon for PubMed Central
Loading ...
Support Center