653. Risk Factors for Pneumocystis jirovecii Pneumonia (PCP) in Patients with Hematologic Malignancies (HM)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Guidelines for primary PCP prophylaxis have been developed for certain high risk populations, but are still lacking for adult patients with HM. Our objective was to identify HM patients who should be targeted for primary PCP prophylaxis.

Methods:

All adult ( ≥18y) HIV-negative HM patients with PCP from 2/1/1999 -2/28/2010 were retrospectively identified from two medical centers. Each case was matched with 4 HM controls without PCP during the same period. Demographic, clinical, radiographic and laboratory data were collected. Data were analyzed using SPSS v 18.0; a p value of ≤ 0.05 was considered to be statically significant.

Results:

Fourteen cases and 55 controls were included in the study period. The study group was 65.2% male (45) and the mean age was 62±15.8 years.  No significant differences were seen in demographics between both the groups. All identified cases had lymphoproliferative HM, the majority of cases (50%) had non-Hodgkin’s lymphoma (NHL), followed by chronic lymphocytic leukemia (CLL) in cases (42.86%).  Autoimmune diseases were more frequent in cases (28.6% vs. 5.5%; p=0.01) including; one autoimmune hemolytic anemia, two uveitis, and one myasthenia gravis. Diabetes was more common in cases than controls (21.4% vs. 5.5%; p=0.06). The Charlson weighted index of comorbidity score was similar in both groups (2.9 ± 0.86 vs. 2.8 ± 1.01; p=0.53). 14% of cases did not receive chemotherapy vs. 33% of controls (p=0.18).  Duration of chemotherapy was similar between cases and controls (mean 292 ± 259.9 vs. 221 ± 147.16 days, p=0.23). Among the chemotherapeutic agents, including corticosteroids, only fludarabine was associated with higher risk for PCP (50% vs. 18%, p= 0.01). Radiation treatment was given to 7% of cases vs. 16% of controls (p=0.38).  There was no difference in total or % lymphocyte count in cases at the time of PCP diagnosis vs. nadir values in controls.

Conclusion:

Patients with lymphoproliferative HM, specifically CLL and NHL, receiving fludarabine or with autoimmune disorders should be considered for PCP primary prophylaxis.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Karam Obeid, MD , Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI
Javier Aguilar, M.D. , Infectious Diseases, Henry Ford Hospital, Detroit, MI
Susan Szpunar, PhD , Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI
Ayad al-Katib, M.D. , Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI
Mamta Sharma, MD , Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI
Ramon Delbusto, M.D. , Infectious Diseases, Henry Ford Hospital, Detroit, MI
Leonard Johnson, MD , Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI

Disclosures:

K. Obeid, None

J. Aguilar, None

S. Szpunar, None

A. al-Katib, None

M. Sharma, None

R. Delbusto, None

L. Johnson, None

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