Pneumocystis jiroveci pneumonia in relation to CD4+ lymphocyte count in patients with B-cell non-Hodgkin lymphoma treated with chemotherapy

Abstract

An increasing incidence of Pneumocystis jiroveci pneumonia (PCP) in patients with B-cell non-Hodgkin lymphoma (B-NHL) receiving rituximab treatment has been reported. We reviewed patients with B-NHL who underwent chemotherapy from 2004 to 2008 at our institution to identify risk factors for PCP development during and after chemotherapy. Among 297 patients with B-NHL, six developed PCP. Of 121 patients (41%) who received PCP prophylaxis with sulfamethoxazole–trimethoprim during chemotherapy, none developed PCP (0%), while among 176 patients (59%) who had no prophylaxis, six (3.4%) developed PCP at a median of 2 months (range: 1–3 months) after starting chemotherapy. Patients with CD4+ lymphocyte counts ≤200/mm³ before chemotherapy had a higher risk of developing PCP (p = 0.045), while a history of rituximab treatment was not related to PCP. CD4+ lymphocyte counts ≤200/mm³ during and after chemotherapy were observed in 18.9% of patients.

Keywords:

• B-cell non-Hodgkin lymphoma
• CD4+ lymphocyte
• Pneumocystis jiroveci pneumonia
• rituximab
• chemotherapy
• prophylaxis

Declaration of interest: This study was supported in part by Grants-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare, 19-3 and 21S-6.