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

TY - JOUR

T1 - 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

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.

U2 - 10.1016/j.jtct.2023.11.017

DO - 10.1016/j.jtct.2023.11.017

M3 - SCORING: Journal article

C2 - 38007092

VL - 30

SP - 235.e1-235.e10

JO - TRANSPL CELL THER

JF - TRANSPL CELL THER

SN - 2666-6375

IS - 2

ER -