Pneumocystis carinii pneumonia associated with profound lymphopenia and abnormal T-lymphocyte subset ratios during treatment for early-stage breast carcinoma

Brunvand, Mark W.; Collins, Carleen; Livingston, Robert B.; Raghu, Ganesh

doi:10.1002/1097-0142(19910501)67:9<2407::aid-cncr2820670932>3.0.co;2-x

Cited by 29 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though multiple studies have shown that HIV-negative oncology patients are at risk for PCP [5,6], how best to define PCP risk and when to use PCP prophylaxis in this setting is not clearly established. Prior to the early 2000s, cases of PCP in the breast cancer population were infrequently described [7,8]. From 1999 to 2001 at our institution, only 17 solid tumor patients underwent sputum induction to look for evidence of PCP; the diagnosis was rarely considered or found [9].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

Waks

Tolaney

Galar

et al. 2015

Breast Cancer Res Treat

View full text Add to dashboard Cite

Opportunistic infection with Pneumocystis jiroveci pneumonia (PCP) has not been recognized as a significant complication of early-stage breast cancer treatment. However, we have observed an increase in PCP incidence among patients receiving chemotherapy for early-stage breast cancer. Herein we identify risk factors for and calculate incidence of PCP in this population. We identified all cases of PCP at Dana-Farber Cancer Institute/Brigham and Women's Hospital (DFCI/BWH) from 1/1/2000 to 12/31/2013 in patients with stage I-III breast cancer treated with an adriamycin/cyclophosphamide (AC)-containing regimen. Nineteen cases of PCP in non-metastatic breast cancer patients were identified. All patients with PCP were diagnosed after receipt of either three or four cycles of AC chemotherapy on a dose-dense schedule. Patients who developed PCP were treated with median 16.4 mg prednisone equivalents/day as nausea prophylaxis for a median 64 days. The overall incidence of PCP among 2057 patients treated with neoadjuvant or adjuvant dose-dense AC for three or more cycles was 0.6 % (95 % confidence interval 0.3-1.0 %). No PCP was diagnosed in 1001 patients treated with non-dose-dense AC. There was one death from PCP. Women receiving dose-dense AC chemotherapy for early-stage breast cancer are at risk for PCP. Administering the same chemotherapy and corticosteroid dose over an 8-week versus 12-week non-dose-dense schedule appears to have created a novel infectious vulnerability. Replacing dexamethasone with alternative anti-emetics may mitigate this risk.

show abstract

Section: Introductionmentioning

confidence: 99%

Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

Waks

Tolaney

Galar

et al. 2015

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…These individuals were found to have profound lymphopenia and reversed CD4/CD8 ratios, with CD4 counts of 128 and 180. 10 …”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jiroveci Pneumonia in an Atypical Host

Reinbolt

Alam

Layman

et al. 2012

Clinical Breast Cancer

View full text Add to dashboard Cite

“…At certain CD4 levels, the risk for AIDS-indicator diseases increases. It has been shown that absolute lymphopenia correlated with PCP in a non-HIV disease (3). Although the lymphocyte count correlates well with declining CD-4 cells and thus progression of disease, we are not aware of recommendations to use this expeditiously on admission, i.e., that with AIDS as a possibility, empiric therapy for PCP should be initiated if the lymphocyte count is low, while the other tests are still pending.…”

Section: Discussionmentioning

confidence: 99%

Absolute lymphocyte count as a predictor of Pneumocystis pneumonia in patients previously unknown to have HIV

Omene

Ferguson

2012

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

This is a retrospective review of patients admitted to an inner city community hospital with community-acquired pneumonia who were ultimately diagnosed with AIDS and Pneumocystis. Absolute lymphocyte count in our hospital is available immediately. In contrast, it can take 48 hours or longer to obtain more specific CD-4 counts and AIDS enzyme-linked immunosorbent assay (ELISA) serology. The association of lymphopenia with ultimate diagnosis of AIDS and Pneumocystis supports immediate empiric treatment for pneumocystis carinii pneumonia (PCP) in our highly HIV prevalent hospital.

show abstract

Pneumocystis carinii pneumonia associated with profound lymphopenia and abnormal T-lymphocyte subset ratios during treatment for early-stage breast carcinoma

Cited by 29 publications

References 18 publications

Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

Pneumocystis jiroveci Pneumonia in an Atypical Host

Absolute lymphocyte count as a predictor of Pneumocystis pneumonia in patients previously unknown to have HIV

Contact Info

Product

Resources

About