Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Prospective review of Pneumocystis Jiroveci pneumonia occurrence in the treatment of solid tumours in a single centre in Western Australia (#242)

Shane Fitzgerald 1 , Dermot Farrell 1 , Kate Flynn 1 , Louise Dowling 1 , Obi Johnson 1 , Adarsh Das 1 , Andrew Dean 1
  1. St John of God Subiaco Hospital, Subiaco, WA, Australia

Background: Pneumocystis Jiroveci pneumonia (PJP) is a life threatening, opportunistic fungal infection, and commonly associated with patients that are immunocompromised such as HIV, post-cytotoxic chemotherapy and haematological malignancies. It is associated with significant mortality, with rates reportedly 30% one-month post diagnosis in some series1. PJP has been increasingly found in patients undergoing first and second line chemotherapy. This is a prospective audit of thirteen cases of PJP in a single institution in WA

Methods: Electronic patient records were reviewed to identify patients who developed PJP in our institution whilst on treatment with chemotherapy for solid tumours. The patients’ records, imaging, pathology, laboratory results and pharmacy records were reviewed 

Results: Thirteen patients were identified who developed PJP whilst on chemotherapy for solid tumours in our audit. These included pancreatic adenocarcinoma (n=7), lung adenocarcinoma (n=3), breast cancer (n=2) and prostate adenocarcinoma (n=1). Age of diagnosis ranged from 50 to 85 years old. Six patients had received first line treatment, and five had received second line at time of diagnosis of PJP. All cases were identified based on clinical context, changes on CT or positive sputum. Nine of the thirteen patients were lymphopenic on diagnosis, with counts of 0.2-1 (reference range 1.0-4.0 x 109/L). All patients were HIV negative. Twelve were treated with high-dose sulfamethoxazole and trimethoprim, and one patient received atovaquone, followed by lifelong prophylaxis thereafter. One patient required intensive care support. Three patients died despite best management.

Conclusion: PJP is being more commonly diagnosed in earlier treatment lines than previously thought. With our cohort, nearly 85% of patients acquired it during first- or second-line treatment. The mortality rate in our cohort was just over 20%. Clinical suspicion of PJP should be considered in all patients presenting with acute respiratory illness whilst on chemotherapy regardless of the number of treatment lines received

  1. 1. Shehbaz, M. et al. (2023) ‘Clinical characteristics and outcomes of Pneumocystis jirovecii pneumonia in cancer patients from a tertiary care hospital’, Cureus [Preprint]. doi:10.7759/cureus.51291.