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

Blood Diseases Department France Federation University Hospital Grand Ouest against Leukemia Angers France; CRCI2NA Angers France

Center for Bone Marrow Transplantation and Department of Pediatric Haematology Oncology University Children's Hospital Infectious Disease Research Program Munster Germany

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 Henri Mondor University Hospital Assistance Publique Hôpitaux de Paris Créteil 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 Haematology Transplantation and Internal Diseases Medical University of Warsaw Warsaw Poland

Department of Mother and Child Pediatric Haematology Oncology Azienda Ospedaliera Universitaria Integrata di Verona Verona Italy

Department of Mother and Child Pediatric Hematology Oncology Azienda Ospedaliera Universitaria Integrata Verona Verona Italy

Department of Stem cell Transplantation University Hospital Eppendorf Hamburg Germany

Division of Infectious Diseases University of Genova Genova Italy; IRCCS Ospedale Policlinico San Martino Genova Italy

EBMT Leiden Study Unit Leiden Netherlands

Haematology Transplant Unit APHP Saint Louis Hospital Paris France

Haematopoietic Stem Cell Transplantation Unit IRCCS Istituto Giannina Gaslini Pediatric Haematology and Oncology Genova Italy

Hematology Bone Marrow Transplant Unit Hospital Sirio Libanes Sao Paulo Brazil

Institute of Hematology Rabin Medical Center Petach Tikva Israel

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

University Hospital Maastricht Maastricht The Netherlands

University Medical Center Ljubljana Slovenia

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