Pegylated Liposomal Doxorubicin Confers a High Risk for Pneumocystis Jirovecii Pneumonia in Patients With Diffuse Large B-Cell Lymphoma

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PURPOSE: Pegylated liposomal doxorubicin (PLD) has emerged as an effective therapeutic option for diffuse large B-cell lymphoma (DLBCL). While demonstrating an improved safety profile compared to conventional doxorubicin, PLD has been associated with a potentially elevated risk of Pneumocystis jirovecii pneumonia (PJP), warranting clinical vigilance. This study aimed to evaluate the association between PLD administtion and PJP development in patients with diffuse large B-cell lymphoma (DLBCL). METHODS: We conducted a comparative analysis of 43 chemotherapy-treated DLBCL patients with PJP versus 195 contemporaneous DLBCL controls without PJP. The evaluation included PLD administration patterns and covariate-adjusted risk assessments. FINGDINGS: The analysis revealed significant differences between PJP cases and controls. Patients who developed PJP were more likely to have received PLD-containing chemotherapy regimens (p = 0.001) and less likely to have received TMP-SMX prophylaxis (p = 0.001). The majority of PJP cases (51.2%) occurred after 3-4 chemotherapy cycles, with an 18.6% case-fatality rate (n = 8). Multivariable logistic regression identified 2 independent predictors, PLD-containing regimen (OR: 3.2, 95% CI: 1.5-6.8; P = 0.003) as a risk factor; TMP-SMX prophylaxis (OR: 0.4, 95% CI: 0.2-0.8; P = 0.003) as a protective factor. Notably, baseline characteristics including demographic parameters, disease stage, ECOG performance status, LDH levels, and IPI scores showed no significant intergroup differences (all P > 0.05). IMPLICATIONS: These findings demonstrate a clinically significant association between PLD-containing regimens and PJP development in DLBCL patients. Regular clinical and radiographic monitoring for PJP symptoms should be implemented and PJP prophylaxis should be strongly considered for all patients receiving PLD-based therapy.

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