No occurrence of Pneumocystis jiroveci (carinii) pneumonia in 120 adults undergoing myeloablative unrelated cord blood transplantation

Abstract: The incidence of pneumonia caused by Pneumocystis carinii (PCP) (organism now renamed Pneumocystis jiroveci) during the early period after cord blood transplantation (CBT) was studied in 120 adults. Initially 89 patients (74%) received oral administration of 2 single‐strength trimethoprim‐sulfamethoxazole (TMP‐SMZ) tablets twice daily from day −21. In 45 of 89 patients (51%), TMP‐SMZ administration for a scheduled duration was completed. In the remaining 44 patients (49%), however, TMP‐SMZ administration was discontinued prior to day −3 because of toxicity. Among these patients, 42 subsequently received aerosolized pentamidine (AP) on a median of day −13 (range, −20 to −6). Thirty‐one patients (26%) received AP without TMP‐SMZ administration on a median of day −14 (range, −21 to −9). None of the 120 patients were diagnosed with PCP within 100 days or 2 years after CBT; however, one patient who received AP before CBT but no prophylaxis after CBT developed cerebral toxoplasmosis on day +91. Pre‐transplant prophylaxis against PCP did not significantly affect transplantation‐related mortality or disease‐free survival at 2 years after CBT. The results suggest that PCP during the early period after CBT can be effectively prevented by any pre‐transplant prophylactic method.