Pneumocystis carinii pneumonia in patients with solid tumors and lymphomas: predisposing factors and outcome

The incidence of Pneumonocystis carinii pneumonia (PCP) is increasing in patients with cancer. The possible routes of transmission in this population, as well as the epidemiological data of PCP, are not very well understood. The collection and analysis of data concerning the predisposing factors for PCP will elucidate this subject.

We studied 26 patients suffering from cancer who developed PCP during the five-year period 1997--2002.

Twenty-one patients had a solid tumor diagnosis while the remaining five had a lymphoma. All of them received intensive combination chemotherapy, while eight of them also received high-dose therapy and bone marrow transplantation. Nineteen of our patients had long hospitalization before the onset of PCP. All of them had received corticosteroids for various reasons. Among them, many patients had been exposed to radiotherapy and, in particular, in fields which encompass the major thoracic duct. Eighteen patients survived after the initiation of appropriate treatment, while eight others succumbed.

In this series, protracted deep lymphopenia, long hospitalization, radiotherapy and intensive chemotherapy were considered serious risk factors for developing PCP.