Pneumocystis jirovecii pneumonia in patients with previously untreated acute myeloid leukaemia

• Published in: Mycoses Vol. 65; no. 2; pp. 233 - 238
• Main Authors: Paterno, Giovangiacinto, Guarnera, Luca, Palmieri, Raffaele, Del Prete, Valentina, Bonanni, Fabrizio, Buzzatti, Elisa, Moretti, Federico, Casciani, Paola, Savi, Arianna, Di Cave, David, Maurillo, Luca, Buccisano, Francesco, Venditti, Adriano, Del Principe, Maria Ilaria
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01.02.2022
• Subjects: acute myeloid leukaemia; Acute myeloid leukemia; Aged; bronchoalveolar lavage; Bronchus; Chemotherapy; Disease prevention; Female; Hematology; high‐resolution computed tomography; HIV; Human immunodeficiency virus; Humans; Immunocompromised hosts; Leukemia; Leukemia, Myeloid, Acute - complications; Male; Multivariate analysis; Patients; Pnemocystis jirovecii; Pnemocystis jirovecii pneumonia; Pneumocystis carinii; Pneumocystis jirovecii; Pneumonia; Pneumonia, Pneumocystis - epidemiology; Prophylaxis; Retrospective Studies; Sulfamethoxazole; Trimethoprim; Pnemocystis jirovecii pneumonia; Pnemocystis jirovecii; acute myeloid leukaemia; high-resolution computed tomography; bronchoalveolar lavage
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/myc.13411

Background Several studies in immunocompromised patients, such as those with HIV infection, undergoing cancer chemotherapy or organ transplant, have led to the development of guidelines on the use of prophylaxis to prevent Pneumocystis jirovecii pneumonia (PJP), in these specific conditions. Instead, since the association between PJP and acute myeloid leukaemia (AML) is not clearly defined, the role of prophylaxis in patients with AML is not yet established. Methods We retrospectively analysed 251 consecutive patients with newly diagnosed non‐M3‐AML, admitted at the Hematology Unit of University Tor Vergata in Rome, during the period 2010–2020. The aim of the study was to evaluate the incidence of PJP among AML patients during their first hospital admission, and to identify subjects at a high risk to develop PJP. Results Among 251 consecutive patients with non‐M3‐AML, 67 bronchoalveolar lavages (BAL) were performed. PJP was proven in 11/67 (16.7%) subjects undergoing BAL (11 males, median age 71 years), with an incidence of 4.3%. The most common reason for BAL execution were radiological findings such as ground‐glass opacities (6/11, 55%) and atypical patterns like consolidations and nodules (5/11, 45%). One patient died because of PJP after 11 days of trimethoprim/sulfamethoxazole therapy. In multivariate analysis older age and smoking habit were independent factors significantly associated with PJP (p = .021 and 0.017 respectively). Conclusion We conclude that PJP infection is not uncommon among patients with AML. If intensive chemotherapy is planned, physicians should be aware of this risk and prophylaxis should be considered, particularly in older patients.