Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy.
Am J Hematol. 2017 Jan;92(1):37-41. doi: 10.1002/ajh.24572. Epub 2016 Nov 12.
Although infectious complications represent a relevant cause of morbidity and mortality in patients with myelofibrosis (MF), little is known about their incidence, outcome and risk factors. We retrospectively evaluated a cohort of 507 MF patients, diagnosed between 1980 and 2014 in five Italian hematology centers, to define the epidemiology of infections and describe the impact of ruxolitinib (RUX) treatment. Overall, 112 patients (22%) experienced 160 infectious events (grade 3-4, 45%) for an incidence rate of 3.9% per patient-year. Infections were mainly bacterial (78%) and involving the respiratory tract (52% of cases). Also, viral (11%) and fungal infections (2%) were recorded. Overall, infections were fatal in 9% of the cases. Among baseline features, high/intermediate-2 IPSS category (HR 1.8, 95%CI:1.2-2.7; P = 0.02) and spleen length ≥10 cm below left costal margin (HR 1.6, 95%CI:1.1-2.5; P = 0.04) were associated with higher infectious risk in multivariate analysis. Overall, the rate of infections was higher in the cohort of 128 RUX-treated patients (44% vs. 20%, P < 0.001). In conclusion, IPSS-category and splenomegaly, emerged as the main risk factors for infections in MF. RUX-treated patients experienced significantly more infection episodes; however, future prospective studies are needed to isolate the confounding contribution of other risk factors such as disease stage. Am. J. Hematol. 92:37-41, 2017. © 2016 Wiley Periodicals, Inc.
虽然感染并发症是骨髓纤维化（MF）患者发病率和死亡率的一个重要原因，但对其发病率、结果和危险因素知之甚少。我们回顾性评估了 507 例 MF 患者的队列，这些患者于 1980 年至 2014 年间在意大利五个血液学中心诊断，以确定感染的流行病学，并描述鲁索替尼（RUX）治疗的影响。总体而言，112 例患者（22%）经历了 160 次感染事件（3-4 级，45%），发病率为 3.9%/患者年。感染主要为细菌性（78%），累及呼吸道（52%）。此外，还记录了病毒性（11%）和真菌性感染（2%）。总体而言，感染导致 9%的病例死亡。在基线特征中，高/中-2 国际预后评分系统（IPSS）类别（HR 1.8，95%CI：1.2-2.7；P=0.02）和脾脏长度≥10cm 超过左侧肋缘（HR 1.6，95%CI：1.1-2.5；P=0.04）与多变量分析中较高的感染风险相关。总体而言，在 128 例接受 RUX 治疗的患者中，感染发生率较高（44%比 20%，P<0.001）。总之，IPSS 类别和脾肿大是 MF 感染的主要危险因素。接受 RUX 治疗的患者感染发作明显更多；然而，未来需要前瞻性研究来分离疾病阶段等其他危险因素的混杂影响。美国血液学杂志 92:37-41,2017。©2016 威利父子公司
