Infection risk and antimicrobial prophylaxis in bendamustine-treated patients with indolent non-Hodgkin lymphoma: An Australasian Lymphoma Alliance study.

Autor: Manos K; Department of Haematology, Flinders Medical Centre, Bedford Park, South Australia, Australia., Churilov L; Department of Medicine, The University of Melbourne Medical School, Melbourne, Victoria, Australia., Grigg A; Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia., Di Ciaccio P; Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.; College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia., Wong J; Department of Haematology, Monash Health, Clayton, Victoria, Australia., Chandra Sekaran U; Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.; Pathwest Laboratory, Nedlands, Western Australia, Australia., Wight J; Department of Haematology and Bone Marrow Transplantation, Townsville Hospital and Health Service, Townsville, Queensland, Australia.; Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia., Goh Z; Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia., Jina H; Department of Haematology, Box Hill Hospital, Box Hill, Victoria, Australia., Butler L; Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia., Yannakou CK; Epworth HealthCare, Melbourne, Victoria, Australia., Hamad N; Department of Haematology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.; Faculty of Medicine and Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia.; School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia., Gregory GP; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Gangatharan S; Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia., Cochrane T; Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia., Hawkes EA; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.; Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Victoria, Australia., Lasica M; Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2024 Jul; Vol. 205 (1), pp. 146-157. Date of Electronic Publication: 2024 Mar 14.
DOI: 10.1111/bjh.19407
Abstrakt: Infection and lymphopenia are established bendamustine-related complications. The relationship between lymphopenia severity and infection risk, and the role of antimicrobial prophylaxis, is not well described. This multicentre retrospective study analysed infection characteristics and antimicrobial prophylaxis in 302 bendamustine-treated indolent non-Hodgkin lymphoma patients. Lymphopenia (<1 × 10 9 /L) was near universal and time to lymphocyte recovery correlated with cumulative bendamustine dose. No association between lymphopenia severity and duration with infection was observed. Infections occurred in 44% of patients (50% bacterial) with 27% hospitalised; 32% of infections occurred ≥3 months post bendamustine completion. Infection was associated with obinutuzumab and/or maintenance anti-CD20 therapy, prior therapy and advanced stage. Twenty-four opportunistic infections occurred in 21 patients: ten varicella zoster virus (VZV), seven herpes simplex virus (HSV), one cytomegalovirus, one progressive multifocal leucoencephalopathy, one nocardiosis, one Pneumocystis jiroveci pneumonia (PJP) and three other fungal infections. VZV/HSV and PJP prophylaxis were prescribed to 42% and 54% respectively. Fewer VZV/HSV infections occurred in patients receiving prophylaxis (HR 0.14, p = 0.061) while PJP prophylaxis was associated with reduced risk of bacterial infection (HR 0.48, p = 0.004). Our study demonstrates a significant infection risk regardless of lymphopenia severity and supports prophylaxis to mitigate the risk of early and delayed infections.
(© 2024 British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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