Pneumocystis jirovecii pneumonia prophylaxis in patients with glioma receiving concurrent chemoradiation: a systematic review and meta-analysis
Abstract
Summary Background Routine antibiotic prophylaxis against pneumocystis jirovecii pneumonia (PJP) is recommended during concurrent temozolomide and radiotherapy (TMZ-RT) for glioma based on early small studies. However, true PJP risk may be far lower, raising questions about the value and harms of universal prophylaxis. Methods We conducted a systematic review (PROSPERO: CRD42021292396) of studies reporting PJP incidence among glioma patients treated with TMZ-RT. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to May 1, 2025. Outcomes included overall PJP incidence and rates stratified by prophylaxis, corticosteroid exposure, and lymphopenia. Findings Of 3791 records, 35 studies (13,637 patients, 12,301 received TMZ-RT) met eligibility criteria. Across 24 studies confirming PJP, 71 cases occurred among 12,056 TMZ-RT patients—a pooled incidence of 0.74% (95% CI, 0.59–0.93%) with minimal heterogeneity (Q = 23.3, p = 0.44; I2 = 1.4%). Seventeen studies detailed prophylaxis: 55.1% (2942/5341) of patients received it; PJP incidence was 0.8% (14/1765) with versus 0.3% (9/2719) without prophylaxis. Baseline corticosteroid exposure was reported in 13 studies (n = 5908: median 49.5%, range 27.3%–82.3%), and grade 3–4 lymphopenia in 15.2% (319/2102) of TMZ-RT patients. Incomplete study-level reporting precluded robust risk factor-adjusted analyses. Interpretation Across heterogeneous populations and study designs, the pooled PJP…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 13,637 participants or records.
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