Occurrence of Pneumocystis Jiroveci Pneumonia After Allogeneic Stem Cell Transplantation: A 6-year Retrospective Study

Bone Marrow Transplant. 2005 Nov;36(10):879-83. doi: 10.1038/sj.bmt.1705149.

Abstract

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.

MeSH terms

  • CD4 Lymphocyte Count
  • Hematologic Neoplasms / complications
  • Hematologic Neoplasms / therapy
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hematopoietic Stem Cell Transplantation / statistics & numerical data
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Incidence
  • Opportunistic Infections / chemically induced
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / prevention & control
  • Pneumonia, Pneumocystis / chemically induced
  • Pneumonia, Pneumocystis / drug therapy
  • Pneumonia, Pneumocystis / prevention & control*
  • Premedication
  • Retrospective Studies
  • Transplantation, Homologous
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Immunosuppressive Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination