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Pneumocystis Pneumonia After Allogeneic Hematopoietic Cell Transplantation: A Case-Control Study on Epidemiology and Risk Factors on Behalf of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation
C. Robin, C. Cordonnier, G. Tridello, N. Knelange, A. Xhaard, S. Chantepie, A. Tanguy-Schmidt, HC. Schouten, M. Yeshurun, V. Rocha, M. Srour, N. Kröger, MP. Ledoux, J. Dalgaard, A. Thiebaut, S. Giardino, E. Calore, T. Zuckerman, AH. Groll, L....
Language English Country United States
Document type Multicenter Study, Journal Article
- MeSH
- Communicable Diseases * etiology MeSH
- Bone Marrow MeSH
- Humans MeSH
- Pneumonia, Pneumocystis * epidemiology etiology diagnosis MeSH
- Risk Factors MeSH
- Case-Control Studies MeSH
- Hematopoietic Stem Cell Transplantation * adverse effects methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
Pneumocystis pneumonia (PCP) is a life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). However, allo-HCT procedures have evolved toward older patients, unrelated donors, and reduced-intensity conditioning, possibly modifying the risks. Polymerase chain reaction (PCR), widely used nowadays, is more sensitive than microscopy diagnostic methods. This study aimed to assess the factors associated with PCP in allo-HCT recipients within 2 years of HCT and managed according to current procedures. This multicenter, nested case-control study included PCP cases diagnosed by PCR, cytology, or immunofluorescence on bronchoalveolar lavage fluid between 2016 and 2018. Two controls per case were selected from the ProMISe registry and matched for the center, transplant date, and underlying disease. Fifty-two cases and 104 controls were included among the 5452 patients who underwent allo-HCT in the participating centers. PCP occurred at a median of 11.5 months after transplantation. The mortality rate was 24% on day 30 after the PCP diagnosis and 37% on day 90. The clinical presentation and mortality rates of the 24 patients diagnosed using only PCR were not different from those diagnosed with microscopy methods. Our study demonstrates a substantial incidence of, and mortality from, PCP, after allogeneic HCT despite well-established prophylactic approaches. In our experience, PCP nowadays occurs later after transplant than previously reported, justifying the prolongation of prophylaxis after six months in many cases. Allo-HCT recipients diagnosed with PCR as the only PCP marker should benefit from specific treatment as for other patients.
Basse Normandie Haematology Institute Caen University Hospital Caen France
Clinic of Haematology and Oncology Tartu University Hospital Tartu Estonia
Clinica di Oncoematologia Pediatrica Azienda Ospedaliera Università di Padova Padova Italy
Department of Haemato Oncology Olomouc University Hospital Olomouc Czech Republic
Department of Haematology and Bone Marrow Transplantation Rambam Medical Center Haifa Israel
Department of Haematology Cancer Institute of Strasburg Strasbourg France
Department of Haematology Grenoble Alpes University Hospital Grenoble France
Department of Haematology Hospital Universitario de La Princesa Madrid Spain
Department of Haematology Lille University Hospital Lille France
Department of Haematology Limoges University Hospital Limoges France
Department of Haematology Oslo University Hospital Rikshospitalet Oslo Norway
Department of Stem cell Transplantation University Hospital Eppendorf Hamburg Germany
Division of Infectious Diseases University of Genova Genova Italy
EBMT Leiden Study Unit Leiden Netherlands
Haematology Transplant Unit APHP Saint Louis Hospital Paris France
Hematology Bone Marrow Transplant Unit Hospital Sirio Libanes Sao Paulo Brazil
Institute of Hematology Rabin Medical Center Petach Tikva Israel
IRCCS Ospedale Policlinico San Martino Genova Italy
Pediatric Haematology and Oncology University Hospital Collegium Medicum UMK Bydgoszcz Poland
Stem cell transplant unit Hospital Niño Jesus Madrid Spain
Université Paris Cité Paris France
References provided by Crossref.org
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