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. 2021 Sep 3;21(1):987.
doi: 10.1186/s12885-021-08727-2.

Clinical characteristics and risk factors associated with Pneumocystis jirovecii infection in patients with solid tumors: study of thirteen-year medical records of a large cancer center

Koichi Takeda  1 , Sohei Harada  2 , Brian Hayama  1 , Kosuke Hoashi  3 , Taisuke Enokida  1 , Toshiharu Sasaki  4 , Koh Okamoto  5 , Kenji Nakano  6 , Daisuke Ohkushi  1
Affiliations

Clinical characteristics and risk factors associated with Pneumocystis jirovecii infection in patients with solid tumors: study of thirteen-year medical records of a large cancer center

Koichi Takeda et al. BMC Cancer. .

Abstract

Background: Pneumocystis jirovecii pneumonia (PCP)-related risk factors among patients with solid tumors are not completely defined. Thus, we aimed to characterize PCP cases with underlying solid tumors, to highlight the factors contributing to its development besides the prolonged use of moderate-to-high dose corticosteroids.

Methods: We retrospectively reviewed the medical records of patients with solid tumors diagnosed with PCP between 2006 and 2018 at a cancer center in Tokyo, Japan. Demographic and clinical data were collected, which included malignancy types, total lymphocyte count, coexisting pulmonary disease, chemotherapy, radiation therapy, corticosteroid use, and PCP-attributable mortality.

Results: Twenty cases of PCP with solid tumors were documented in 151,718 patients and 788,914 patient-years. Lung cancer (n = 6, 30%) was the most common underlying tumor, followed by breast cancer (n = 3, 15%). Only six (30%) patients were taking a dosage of ≥20 mg prednisone equivalents daily for ≥4 weeks from the onset of PCP. Among the remaining 14 patients, seven (50%) had coexisting pulmonary diseases, 10 (71%) had received chemotherapy within 90 days prior to PCP diagnosis, seven (50%) had undergone chest radiation therapy before PCP diagnosis, seven (50%) had received only intermittent corticosteroids, and one (7%) received no corticosteroids. Mortality attributable to PCP was 40%.

Conclusions: More than half of the patients were not taking a dosage of ≥20 mg prednisone equivalents daily for ≥4 weeks. Multiple other factors (e.g., lymphocytopenia, radiation to chest) may have potentially contributed to PCP in patients with solid tumors in a composite manner. We need to establish a method for estimating the likelihood of PCP taking multiple factors into account in this patient population.

Keywords: Beta-D-glucans; Corticosteroids; Invasive fungal infections; Mycoses; Pneumocystis jirovecii; Solid tumors.

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Conflict of interest statement

SH has received honoraria from MSD, Shionogi, Astellas, BD, Beckman Coulter Diagnostics, Sumitomo Dainippon Pharma, and Meiji; has served in a consultancy/advisory role for FUJIFILM Toyama Chemical; and has received research funding from MSD, outside the submitted work. BH has received honoraria from Janssen Pharmaceutica, outside the submitted work. DO has received Honoraria from Sumitomo Dainippon, outside the submitted work. All other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart showing the inclusion and exclusion criteria applied in the selection of the study population. P. jirovecii, Pneumocystis jirovecii; PCR, polymerase chain reaction; BDG, beta-D-glucan; PCP, Pneumocystis jirovecii pneumonia
Fig. 2
Fig. 2
Chest CT findings in patients with ground glass opacities. Patient No. 13 (a) and Patient No. 14 (b) shown in Table 3
See this image and copyright information in PMC

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