{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:13:49Z","timestamp":1777515229704,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,6,15]],"date-time":"2013-06-15T00:00:00Z","timestamp":1371254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Fludarabine, cyclophosphamide and rituximab (<jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content>) therapy for lymphoid malignancies has historically been associated with a low reported incidence of <jats:italic><jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>neumocystis jirovecii<\/jats:italic> pneumonia (<jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content>). However, prophylaxis was routinely used in early studies, and molecular diagnostic tools were not employed. The objective of this study was to review the incidence of <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content> during and post\u2010<jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> in the era of highly sensitive molecular diagnostics and <jats:sup>18<\/jats:sup>F\u2010fluorodeoxyglucose (<jats:styled-content style=\"fixed-case\">FDG<\/jats:styled-content>) positron emission tomography (<jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>)\u2013computerised tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients treated with standard <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> at the <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>eter <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>ac<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>allum <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ancer <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>entre (<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>arch 2009 to <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>une 2012) were identified from a medications management database. Laboratory\u2010confirmed <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content> cases during this time were identified from an electronic database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 66 patients were treated with a median of 5.5 <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> cycles. Eight <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content> cases were identified, 6 of whom had received chemotherapy prior to <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content>. In 5 cases, <jats:sup>18<\/jats:sup>F\u2010<jats:styled-content style=\"fixed-case\">FDG PET<\/jats:styled-content> demonstrated bilateral ground\u2010glass infiltrates. Median <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4<jats:sup>+<\/jats:sup> lymphocyte counts at time of <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content> diagnosis and 9\u201312\u00a0months following <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> were 123 and 400\u00a0cells\/\u03bcL, respectively. In patients receiving no prophylaxis, 9.1% developed <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content> during <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content>. The rate following <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> was 18.4%, with median onset at 6\u00a0months (2.4\u201324\u00a0months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Given the high rate of late\u2010onset <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content>, consideration should be given for extended <jats:styled-content style=\"fixed-case\">PJP<\/jats:styled-content> prophylaxis for up to 12\u00a0months post\u2010<jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content>, particularly in pretreated patients. Further evaluation of the role of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4<jats:sup>+<\/jats:sup> monitoring is warranted to quantify risk of disease development and to guide duration of prophylaxis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ejh.12135","type":"journal-article","created":{"date-parts":[[2013,5,13]],"date-time":"2013-05-13T14:42:40Z","timestamp":1368456160000},"page":"157-163","source":"Crossref","is-referenced-by-count":23,"title":["Late\u2010onset <i><scp>P<\/scp>neumocystis jirovecii<\/i> pneumonia post\u2013fludarabine, cyclophosphamide and rituximab: implications for prophylaxis"],"prefix":"10.1111","volume":"91","author":[{"given":"Gabrielle M.","family":"Haeusler","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Infection Control Peter MacCallum Cancer Centre East Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica A.","family":"Slavin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Infection Control Peter MacCallum Cancer Centre East Melbourne Vic. Australia"},{"name":"Department of Medicine University of Melbourne Parkville Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F.","family":"Seymour","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Melbourne Parkville Vic. Australia"},{"name":"Department of Haematology Peter MacCallum Cancer Centre East Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senthil","family":"Lingaratnam","sequence":"additional","affiliation":[{"name":"Pharmacy Department Peter MacCallum Cancer Centre East Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin W.","family":"Teh","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Infection Control Peter MacCallum Cancer Centre East Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantine S.","family":"Tam","sequence":"additional","affiliation":[{"name":"Department of Haematology Peter MacCallum Cancer Centre East Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin A.","family":"Thursky","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Infection Control Peter MacCallum Cancer Centre East Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leon J.","family":"Worth","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Infection Control Peter MacCallum Cancer Centre East Melbourne Vic. 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