Pneumocystis jirovecii pneumonia prophylaxis in patients with glioma receiving concurrent chemoradiation: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: 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: = 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 incidence associated with TMZ-RT was 0.74% (95% CI, 0.59-0.93%). Due to the heterogeneity in study populations and designs, lack of standardized diagnostic confirmation, and incomplete reporting of steroid administration, this finding should be interpreted with caution. Currently available evidence suggests the risk of PJP is lower than the commonly cited 3.5% threshold for prophylaxis. Well-designed prospective studies are needed to clarify true infection risk and inform prophylaxis decisions. Funding: The Deanship of Graduate Studies and Scientific Research at Qassim University provided financial support for the article processing charge (APC) of this manuscript.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".