Lingaratnam Senthil M, Slavin Monica A, Thursky Karin A, Teh Benjamin W, Haeusler Gabrielle M, Seymour John F, Rischin Danny, Worth Leon J
Pharmacy Department, Peter MacCallum Cancer Centre , East Melbourne , Australia.
Leuk Lymphoma. 2015 Jan;56(1):157-62. doi: 10.3109/10428194.2014.911861.
Pneumocystis jirovecii pneumonia (PJP) is seen increasingly in non-human immunodeficiency virus (HIV) infected immunocompromised populations, but few cases have previously been reported in association with gemcitabine therapy. We identified all patients administered gemcitabine between March 2009 and December 2012 at the Peter MacCallum Cancer Centre. Cases of PJP were identified using accepted definitions. Overall, 288 gemcitabine-treated patients were identified. Nine cases of PJP were detected, corresponding to an overall rate of 3.1% (95% confidence interval [CI] 1.5-5.7%). PJP was diagnosed during gemcitabine therapy in seven patients, a median of 67 (range 31-109) days from commencement. Among patients with lymphoma, 4/22 developed PJP, corresponding to a rate of 18.2% (95% CI 6.1-38.2%). Fewer infections were associated with breast, lung and gastrointestinal malignancies (1/24 [4.2%], 3/118 [2.5%] and 1/61 [1.6%], respectively). A risk-based tool incorporating concomitant steroid therapy can be applied to target high-risk populations who would benefit from PJP prophylaxis during gemcitabine therapy.
耶氏肺孢子菌肺炎（PJP）在非人类免疫缺陷病毒（HIV）感染的免疫功能低下人群中越来越常见，但此前很少有与吉西他滨治疗相关的病例报道。我们确定了2009年3月至2012年12月期间在彼得·麦卡勒姆癌症中心接受吉西他滨治疗的所有患者。PJP病例根据公认的定义进行确定。总体而言，共确定了288例接受吉西他滨治疗的患者。检测到9例PJP病例，总体发生率为3.1%（95%置信区间[CI]1.5 - 5.7%）。7例患者在吉西他滨治疗期间被诊断为PJP，从开始治疗起的中位时间为67天（范围31 - 109天）。在淋巴瘤患者中，22例中有4例发生PJP，发生率为18.2%（95%CI 6.1 - 38.2%）。与乳腺癌、肺癌和胃肠道恶性肿瘤相关的感染较少（分别为24例中的1例[4.2%]、118例中的3例[2.5%]和61例中的1例[1.6%]）。一种结合了同时使用类固醇治疗的基于风险的工具可用于确定在吉西他滨治疗期间可能从PJP预防中获益的高危人群。
