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High incidence of Pneumocystis jirovecii pneumonia in allogeneic hematopoietic cell transplant recipients in the modern era.

现代异基因造血细胞移植受者卡氏肺孢子虫肺炎发病率高。

  • 影响因子:3.53
  • DOI:10.1016/j.jcyt.2019.11.002
  • 作者列表:"Evernden C","Dowhan M","Dabas R","Chaudhry A","Kalra A","Dharmani-Khan P","Gregson D","Johnson A","Jupp J","Jimenez-Zepeda V","Jamani K","Duggan P","Tay J","Khan F","Daly A","Storek J
  • 发表时间:2020-01-01
Abstract

BACKGROUND:International guidelines for Pneumocystis jirovecii pneumonia (PJP) prevention recommend prophylaxis for ≥6 months following allogeneic hematopoietic cell transplantation, and longer in patients with graft-versus-host disease (GVHD) or on immunosuppressive therapy (IST). These recommendations are based on cohorts of patients who did not routinely receive anti-thymocyte globulin (ATG) for GVHD prophylaxis. METHODS:We performed a retrospective chart review of 649 patients, all of whom received ATG as part of GVHD prophylaxis. RESULTS:The cumulative incidence of definite PJP was 3.52% at both 3 and 5 years (median follow up, 1648 days for survivors). PJP occurred in 13 non-GVHD patients between days 207 and 508, due in part to low CD4 T-cell counts (<200 CD4 T cells/µL). PJP occurred in eight GVHD patients between days 389 and 792, due in part to non-adherence to PJP prophylaxis guidelines (discontinuation of PJP prophylaxis at <3 months after discontinuation of IST). Breakthrough PJP infection was not observed in patients receiving prophylaxis with cotrimoxazole, dapsone or atovaquone, whereas three cases were observed with inhaled pentamidine. DISCUSSION:In conclusion, for non-GVHD patients receiving ATG-containing GVHD prophylaxis, 6 months of PJP prophylaxis is inadequate, particularly if the CD4 T-cell count is <200 cells/µL or if there is a high incidence of PJP in the community. For patients with GVHD receiving ATG-containing GVHD prophylaxis, continuing PJP prophylaxis until ≥3 months post-discontinuation of IST is important. Cotrimoxazole, dapsone and atovaquone are preferred over inhaled pentamidine.

摘要

背景: 国际肺孢子菌肺炎 (PJP) 预防指南建议异基因造血细胞移植后预防时间 ≥ 6个月,移植物抗宿主病 (GVHD) 或免疫抑制治疗 (IST) 患者预防时间更长。这些建议基于未常规接受抗胸腺细胞球蛋白 (ATG) 预防GVHD的患者队列。 方法: 我们对649例患者进行了回顾性图表回顾,所有患者都接受了ATG作为GVHD预防的一部分。 结果: 3年和5年时,明确PJP的累积发生率均为3.52% (中位随访时间,存活者为1648天)。在207至508天之间,13例非GVHD患者发生了PJP,部分原因是低CD4 T细胞计数 (<200 CD4 T细胞/μ l)。在389至792天之间,8名GVHD患者发生了PJP,部分原因是不遵守PJP预防指南 (在停止IST后 <3个月停止PJP预防)。在接受复方新诺明、氨苯砜或阿托伐奎酮预防治疗的患者中,未观察到突破性PJP感染,而吸入五脒组中观察到3例。 讨论: 总之,对于接受含ATG的GVHD预防的非GVHD患者,6个月的PJP预防是不够的,特别是如果CD4 + T细胞计数 <200个细胞/μ l或社区中PJP的发病率高。对于接受含ATG的GVHD预防的GVHD患者,继续PJP预防直至IST停药后 ≥ 3个月是重要的。优选复方新诺明、氨苯砜和阿托伐喹,而非吸入性戊脒。

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影响因子:2.36
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