Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Support Care Cancer. 2018 Jul;26(7):2425-2431. doi: 10.1007/s00520-018-4079-3. Epub 2018 Feb 9.
Available data suggest that respiratory infections are associated with increased morbidity and mortality in patients hospitalized due to acute leukemia and allogeneic stem cell transplantation (allo-SCT). However, the precise incidence, risk factors, and severity of respiratory infection, mainly community-acquired, in patients with lymphoma and multiple myeloma (MM) are not fully determined. The current study aimed to investigate risk factors for respiratory infections and their clinical significance in patients with B cell non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) in the first year of diagnosis.
Data of consecutive patients diagnosed with NHL or MM and treated at the Rambam Hematology Inpatient and Outpatient Units between 01/2011 and 03/2012 were evaluated. Information regarding anticancer treatment, incidence and course of respiratory infections, and infection-related outcomes was analyzed.
One hundred and sixty episodes of respiratory infections were recorded in 103 (49%) of 211 (73-MM, 138-NHL) patients; 126 (79%) episodes were community-acquired, 47 (29%) of them required hospitalization. In univariate analysis, age < 60 years, MM diagnosis, and autologous SCT increased the respiratory infection risk (P = 0.058, 0.038, and 0.001, respectively). Ninety episodes (56% of all respiratory episodes) were examined for viral pathogens. Viral infections were documented in 25/90 (28%) episodes, 21 (84%) of them were community-acquired, requiring hospitalization in 5 (24%) cases. Anti-flu vaccination was performed in 119 (56%) patients. Two of the six patients diagnosed with influenza were vaccinated.
Respiratory infections, including viral ones, are common in NHL and MM. Most infections are community-acquired and have a favorable outcome. Rapid identification of viral pathogens allows avoiding antibiotic overuse in this patient population.
现有数据表明，呼吸道感染与因急性白血病和异基因干细胞移植（allo-SCT）而住院的患者的发病率和死亡率增加有关。然而，淋巴瘤和多发性骨髓瘤（MM）患者中，主要为社区获得性的呼吸道感染的确切发病率、危险因素和严重程度尚未完全确定。本研究旨在调查初诊的 B 细胞非霍奇金淋巴瘤（NHL）和多发性骨髓瘤（MM）患者发生呼吸道感染的危险因素及其临床意义。
评估了 2011 年 1 月至 2012 年 3 月期间在 Rambam 血液科住院和门诊连续就诊的 NHL 或 MM 患者的数据。分析了抗癌治疗、呼吸道感染的发生率和病程以及与感染相关的结局的信息。
103 例（73 例 MM，138 例 NHL）211 例患者中记录了 160 例呼吸道感染发作；126 例（79%）为社区获得性，其中 47 例（29%）需要住院治疗。单因素分析显示，年龄<60 岁、MM 诊断和自体 SCT 增加了呼吸道感染的风险（P=0.058、0.038 和 0.001）。90 例（所有呼吸道感染发作的 56%）进行了病毒病原体检测。在 25/90 例（28%）检测到病毒感染中，21 例（84%）为社区获得性，其中 5 例（24%）需要住院治疗。119 例（56%）患者接受了流感疫苗接种。在 6 例确诊流感的患者中，有 2 例接受了疫苗接种。
呼吸道感染，包括病毒感染，在 NHL 和 MM 中很常见。大多数感染为社区获得性，预后良好。快速鉴定病毒病原体可避免此类患者人群中抗生素的过度使用。
