The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: A CIBMTR analysis

K. M. Williams, K. W. Ahn, M. Chen, M. D. Aljurf, A. L. Agwu, A. R. Chen, T. J. Walsh, P. Szabolcs, M. J. Boeckh, J. J. Auletta, C. A. Lindemans, J. Zanis-Neto, M. Malvezzi, J. Lister, J. S. De Toledo Codina, K. Sackey, J. L H Chakrabarty, P. Ljungman, J. R. Wingard, M. D. SeftelS. Seo, G. A. Hale, B. Wirk, M. S. Smith, B. N. Savani, H. M. Lazarus, D. I. Marks, C. Ustun, H. Abdel-Azim, C. C. Dvorak, J. Szer, J. Storek, A. Yong, M. R. Riches

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


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 Center for International Blood and Marrow Transplant Research 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, the 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.

Original languageEnglish (US)
Pages (from-to)573-580
Number of pages8
JournalBone marrow transplantation
Issue number4
StatePublished - Apr 1 2016

Bibliographical note

Funding Information:
The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ∗Actinium Pharmaceuticals; Allos Therapeutics, Inc.; ∗Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; ∗Blue Cross and Blue Shield Association; ∗Celgene Corporation; Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Fresenius-Biotech North America, Inc.; ∗Gamida Cell Teva Joint Venture Ltd; Genentech, Inc.; ∗ Gentium SpA; Genzyme Corporation; GlaxoSmithKline; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Jeff Gordon Children's Foundation; Kiadis Pharma; The Leukemia & Lymphoma Society; Medac GmbH; The Medical College of Wisconsin; Merck & Co, Inc.; Millennium: The Takeda Oncology Co.; ∗Milliman USA, Inc.; ∗Miltenyi Biotec, Inc.; National Marrow Donor Program; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Osiris Therapeutics, Inc.; Otsuka America Pharmaceutical, Inc.; Perkin Elmer, Inc.; ∗Remedy Informatics; ∗Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix, Inc.; St. Baldrick's Foundation; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc.; Swedish Orphan Biovitrum; ∗Tarix Pharmaceuticals; ∗TerumoBCT; ∗Teva Neuroscience, Inc.; ∗THERAKOS, Inc.; University of Minnesota; University of Utah; and ∗Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the U.S. Government.

Publisher Copyright:
© 2016 Macmillan Publishers Limited.


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