TY - JOUR
T1 - Pneumocystis pneumonia after allogeneic hematopoietic cell transplantation
T2 - 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
AU - Robin, Christine
AU - Cordonnier, Catherine
AU - Tridello, Gloria
AU - Knelange, Nina
AU - Xhaard, Alienor
AU - Chantepie, Sylvain
AU - Tanguy-Schmidt, Aline
AU - Schouten, Harry C
AU - Yesherun, Moshe
AU - Rocha, Vanderson
AU - Srour, Micha
AU - Kröger, Nicolaus
AU - Ledoux, Marie-Pierre
AU - Dalgaard, Jakob
AU - Thiebaut, Anne
AU - Giardino, Stefano
AU - Calore, Elisabetta
AU - Zuckerman, Tsila
AU - Groll, Andreas H
AU - Raida, Ludek
AU - Avcin, Simona
AU - Vicent, Marta Gonzalez
AU - Kaare, Ain
AU - Drozd-Sokolowska, Joanna
AU - Turlure, Pascal
AU - Bretagne, Stéphane
AU - Mikulska, Malgorzata
AU - Camara, Rafael de la
AU - Cesaro, Simone
AU - Styczynski, Jan
PY - 2024/2
Y1 - 2024/2
N2 - 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.
AB - 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.
KW - Allogeneic HCT
KW - Pneumocystys jirovecii
KW - broncho-alveolar lavage
KW - pneumocystosis
KW - quantitative polymerase chain reaction
U2 - 10.1016/j.jtct.2023.11.017
DO - 10.1016/j.jtct.2023.11.017
M3 - Article
SN - 2666-6375
VL - 30
SP - 235.e1-235.e10
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 2
ER -