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Pneumocystis jirovecii pneumonia prophylaxis in allogeneic hematopoietic cell transplant recipients: can we always follow the guidelines?

Bone Marrow Transplantation volume 54, pages 1082–1088 (2019)Cite this article

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Abstract

Pneumocystis jirovecii pneumonia (PCP) is a life-threatening disease in allogeneic hematopoietic cell transplantation (HCT) recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred prophylaxis but has significant toxicity. We assessed 139 consecutive HCT patients for PCP prophylaxis in our center. According to our procedures, TMP-SMX should be given as first-line prophylaxis from engraftment. In case of intolerance, atovaquone (ATO) or aerosolized pentamidine may be given. Thirteen (9.3%) patients did not receive prophylaxis because they early died. Of the 126 prophylaxed patients, 113 (90%) received TMP-SMX and 13 (10%) received ATO as first-line regimen. However, only 51/113 (45%) patients received TMP-SMX as the sole prophylaxis: 60 patients were switched to ATO because of side effect. There were 18 PCP cases: 3 occurred before engraftment, 7 occurred under ATO, 3 occurred while prophylaxis was pending the resolution of side effects, and 5 occurred after stopping prophylaxis. No cases occurred under TMP-SMX while 7 (9.6%) cases occurred under first-(n = 13) or second (n = 60)-line ATO. There are many concerns about PCP prophylaxis after HCT: patients may develop PCP before engraftment or several months after stopping immunosuppressors, and half of them do not receive TMP-SMX all along the at-risk periods. New prophylactic drugs and strategies should be evaluated.

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Acknowledgements

The authors are grateful to the technical staff of the Laboratory of Mycology and to the physicians and nurses of the Department of Hematology, and of the Pneumology, and Intensive Care Units of Henri Mondor Hospital.

Author contributions

RR, CR and CC contributed to the initial conception and designed the study. RR, CR, FF, ML, FB1, RDB, CP and AT provided the study materials or patients. RR, CR, FF and FB2 collected and assembled the data. CR performed the statistical analyses. RR, CR, SM and CC wrote the manuscript. All authors gave the final approval to the manuscript.

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Author notes

  1. These authors contributed equally: Rabah Redjoul, Christine Robin

Authors and Affiliations

  1. Department of Hematology and Cellular Therapy, Assistance Publique-Hôpitaux de Paris; Henri Mondor Hospital, 94000, Créteil, France

    Rabah Redjoul, Christine Robin, Mathieu Leclerc, Florence Beckerich, Ludovic Cabanne, Roberta di Blasi, Cécile Pautas, Andrea Toma, Sébastien Maury & Catherine Cordonnier

  2. University Paris-Est Créteil (UPEC), 94000, Créteil, France

    Christine Robin, Francoise Foulet, Mathieu Leclerc, Francoise Botterel, Sébastien Maury & Catherine Cordonnier

  3. Parasitology Unit, Microbiology Department, Henri Mondor Hospital, 94000, Créteil, France

    Francoise Foulet & Francoise Botterel

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  1. Rabah Redjoul
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Correspondence to Catherine Cordonnier.

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Redjoul, R., Robin, C., Foulet, F. et al. Pneumocystis jirovecii pneumonia prophylaxis in allogeneic hematopoietic cell transplant recipients: can we always follow the guidelines?. Bone Marrow Transplant 54, 1082–1088 (2019). https://doi.org/10.1038/s41409-018-0391-2

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