Incidence, clinical presentation, and outcomes of Pneumocystis pneumonia when utilizing Polymerase Chain Reaction-based diagnosis in patients with Hodgkin lymphoma

Abstract

A Polymerase Chain Reaction-based diagnosis of Pneumocystis Pneumonia (PCP) and the need for anti-Pneumocystis prophylaxis in Hodgkin lymphoma patients receiving chemotherapy requires further investigation. This retrospective, single-center, study evaluated 506 consecutive adult patients diagnosed with Hodgkin lymphoma receiving chemotherapy between January 2006 and August 2018. The cumulative incidence of PCP 1 year after start of chemotherapy was 6.2% (95% CI 3.8–8.5%). Mortality 30 days from PCP diagnosis was 8% (n = 2) with one death attributable to PCP. Bleomycin-containing combination chemotherapy regimen was not significantly associated with a higher risk for PCP when compared to other regimens (HR = 1.59, 95% CI 0.55–4.62 p = 0.40). Anti-Pneumocystis prophylaxis was not significantly associated with a decreased incidence of PCP (HR = 0.51, 95% CI 0.15–1.71, p = 0.28). As the overall incidence is above the commonly accepted 3.5% threshold, clinicians should consider the potential value of prophylaxis. The utility of universal vs. targeted anti-Pneumocystis prophylaxis requires prospective, randomized investigation.

Keywords:

• Pneumocystis jirovecii
• pneumonia
• Hodgkin lymphoma
• Polymerase Chain Reaction
• trimethoprim
• sulfamethoxazole
• infection

Disclosure statement

None of the authors have any financial or other conflicts of interest relevant to the contents of this manuscript.

Author contributions

Conceptualization and methodology: JNB, CAT, PMW, KCM, PKT, AHL; Data curation, formal analysis, and interpretation: JNB, CAT, PMW, KCM, AGP, ALP, PKT, AHL; Writing – original draft: JNB, CAT, PMW, KCM, AGP, ALP, PKT, AHL; Writing – review and editing: JNB, CAT, PMW, KCM, AGP, ALP, PKT, AHL. Guarantors of the work: JNB, CAT, AHL.

Additional information

Funding

This publication was supported by CTSA (Grant TL1 TR002380) from the National Center for Advancing Translational Science (NCATS) and the National Institutes of Health (Grant R01-HL62150; to AHL).