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- Title
Late‐onset Pneumocystis jirovecii pneumonia post‐allogeneic stem cell transplantation after time‐dependent discontinuation of prophylaxis.
- Authors
Stavi, Vered; Desai, Nihar; Michelis, Fotios V.; Kim, Dennis Dong Hwan; Kumar, Rajat; Lipton, Jeffrey Howard; Law, Arjun Datt
- Abstract
Introduction: Pneumocystis jirovecii pneumonia (PJP) is a rare complication of hematopoietic stem cell transplantation (HSCT). Primary prophylaxis for 6–12 months post‐HSCT is the standard approach. However, there is no consensus regarding the optimal duration of prophylaxis. Methods: We identified patients who developed PJP more than 1‐year post‐HSCT. All patients had previously received 12 months of PJP prophylaxis. PJP was diagnosed based on clinical findings and the detection of P. jirovecii in bronchoalveolar lavage (BAL) using polymerase chain reaction (PCR). The CD4+ T‐cell percentage was determined using flow cytometry. Data expressed as median (interquartile range). Results: Ten patients developed PJP at 17.5 months (16–24 months) post‐HSCT. PJP diagnosis occurred 5.5 months (3–15 months) after discontinuing prophylaxis. Eight patients received anti‐thymocyte globulin (ATG) as graft versus host disease (GVHD) prophylaxis. At diagnosis, only one patient had lymphopenia; all patients had CD4+ T‐lymphocyte counts ≥0.2 × 109/L (median 0.337 × 109/L). Three patients had concomitant bacterial infections. The clinical presentation was mild; only three required hospitalization, none of them required intensive care and there were no deaths. Conclusion: There is a need to develop risk‐adapted prophylactic strategies in the contemporary era using ATG‐based GVHD prophylaxis.
- Subjects
LYMPHOPENIA; PNEUMOCYSTIS pneumonia; STEM cell transplantation; HEMATOPOIETIC stem cell transplantation; GRAFT versus host disease; PREVENTIVE medicine
- Publication
European Journal of Haematology, 2024, Vol 112, Issue 3, p433
- ISSN
0902-4441
- Publication type
Article
- DOI
10.1111/ejh.14133