Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres

Abstract

Summary. A retrospective survey was conducted over a 10-year period (1990-99) among 52 haematology divisions in order to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating haematological diseases. The study included 55 patients (18 with non-Hodgkin's lymphoma, 10 with acute lymphoblastic leukaemia, eight with acute myeloid leukaemia, five with chronic myeloid leukaemia, four with chronic lymphocytic leukaemia, four with multiple myeloma, three with myelodysplastic syndrome, two with myelofibrosis and one with thalassemia) who developed PCP. Among these, 18 (33%) underwent stem cell transplantation; only two received an oral prophylaxis with trimethroprim/sulphamethoxazole. Twelve patients (22%) developed PCP despite protective isolation in a laminar airflow room. The most frequent symptoms were: fever (86%), dyspnoea (78%), non-productive cough (71%), thoracic pain (14%) and chills (5%); a severe hypoxaemia was present in 39 patients (71%). Chest radiography or computerized tomography showed interstitial infiltrates in 34 patients (62%), alveolar infiltrates in 12 patients (22%), and alveolar-interstitial infiltrates in nine patients (16%). Bronchoalveolar lavage was diagnostic in 47/48 patients, induced sputum in 9/18 patients and lung biopsy in 3/8 patients. The diagnosis was made in two patients at autopsy. All patients except one started a specific treatment (52 patients trimethroprim/sulphamethoxazole, one pentamidine and one dapsone). Sixteen patients (29%) died of PCP within 30 d of diagnosis. Multivariate analysis showed that prolonged steroid treatment (P < 0AE006) and a radiological picture of diffuse lung involvement (P < 0AE003) were negative diagnostic factors.

Pneumocystis carinii pneumonia in chronic lymphocytic leukaemia

“…3 5-8 In one large series the occurrence of P carinii pneumonia in four patients with CLL is described but no clinical details regarding treatment or CD4 counts are provided. 3 Hypogammaglobulinaemia is probably the most important immune defect in terms of risk of severe bacterial infections in CLL patients. In patients with CLL, hypogammaglobulinaemia shows a prevalence from 10% to 100% and is correlated with the duration of the disease and with the stage of CLL.…”

Fatal pneumocystis jiroveci pneumonia in ABVD-treated Hodgkin lymphoma patients

“…In HIV patients, a CD4-level below 200 cells/microliter is the accepted criterion, but in nonHIV patients, this limit is not valid enough and there is no other adequate marker of the degree of T cell suppression [6]. Most patients in previous reports have received steroids [2][3][4], but severe infection in nonsteroid-treated patients have also been reported [1,6]. Thus, clinical data are necessary to identify which patients should be considered for prophylaxis.…”

“…Dear Editor, Lung infections are serious complications in patients with hematological malignancies [1][2][3][4]. Pneumocystis jiroveci is an important causative organism.…”

Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients

“…In a recent retrospective study of 55 patients with hematologic disorders, the incidence of PCP in ALL was only 0.5%; this may reflect differences in chemotherapeutic regimens, geographic variation, or prophylaxis (128). Other than bone marrow transplant recipients (28 patients), affected patients had non-Hodgkin's lymphoma (10 patients), ALL (6 patients), acute myeloid leukemia (4 patients), chronic lymphocytic leukemia (4 patients), multiple myeloma (1 patient), myelodysplastic syndrome (1 patient), or myelofibrosis (1 patient).…”