The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: a CIBMTR analysis.
The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: a CIBMTR analysis.
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DOI：
10.1038/bmt.2015.316
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发表时间：
2016-04
影响因子：
4.8
通讯作者：
Riches MR
中科院分区：
文献类型：
--
作者：
Williams KM;Ahn KW;Chen M;Aljurf MD;Agwu AL;Chen AR;Walsh TJ;Szabolcs P;Boeckh MJ;Auletta JJ;Lindemans CA;Zanis-Neto J;Malvezzi M;Lister J;de Toledo Codina JS;Sackey K;Chakrabarty JL;Ljungman P;Wingard JR;Seftel MD;Seo S;Hale GA;Wirk B;Smith MS;Savani BN;Lazarus HM;Marks DI;Ustun C;Abdel-Azim H;Dvorak CC;Szer J;Storek J;Yong A;Riches MR
肺孢子虫肺炎（PJP）与造血干细胞移植（HSCT）后的高发病率和死亡率相关。HSCT后PJP感染知之甚少，因为常规预防的疾病很少。我们报告了一项CIBMTR研究的结果，该研究评估了自体和异体HSCT后PJP的发生率、时间、预防剂、危险因素和死亡率。1995 ~ 2005年，首次HSCT的异基因受者和自体受者中分别有0.63%和0.28%发生PJP。病例发生在allo HSCT后30天至1年以上。巢式病例队列分析与补充数据（n=68 allo病例，n=111 allo对照）显示，PJP感染的危险因素包括淋巴细胞减少症和HSCT后的不匹配。同种异体或自体HSCT后，病例组的总生存率显著低于对照组（p=0.0004）。在控制了重要变量后，比例风险模型显示PJP病例的死亡可能性是匹配对照组的6.87倍（p<0.0001）。我们的结论是PJP感染是罕见的HSCT后，但与高死亡率。与GVHD和免疫重建不良相关的因素是PJP的危险因素之一，提示高危HSCT受者PJP的长期预防可能会改善结局。
Pneumocystis jiroveci pneumonia (PJP) is associated with high morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Little is known about PJP infections after HSCT because of the rarity of disease given routine prophylaxis. We report the results of a CIBMTR study evaluating the incidence, timing, prophylaxis agents, risk factors, and mortality of PJP after autologous (auto) and allogeneic (allo) HSCT. Between 1995 and 2005, 0.63% allo recipients and 0.28% auto recipients of first HSCT developed PJP. Cases occurred as early as 30 days to beyond a year after allo HSCT. A nested case cohort analysis with supplemental data (n=68 allo cases, n=111 allo controls) revealed that risk factors for PJP infection included lymphopenia and mismatch after HSCT. After allo or auto HSCT, overall survival was significantly poorer among cases vs. controls (p=0.0004). After controlling for significant variables, proportional hazards model revealed that PJP cases were 6.87 times more likely to die vs. matched controls (p<0.0001). We conclude PJP infection is rare after HSCT but is associated with high mortality. Factors associated with GVHD and with poor immune reconstitution are among the risk factors for PJP and suggest that protracted prophylaxis for PJP in high-risk HSCT recipients may improve outcomes.