Division of Infectious Diseases, University of California, San Francisco.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Clin Infect Dis. 2019 Jan 7;68(2):247-255. doi: 10.1093/cid/ciy458.
Bendamustine is a potent chemotherapy agent increasingly used to treat indolent non-Hodgkin lymphoma (iNHL). While effective, it causes significant T-cell lymphopenia, which may increase risk of infection. We examined infectious complications associated with bendamustine-containing regimens among older patients with iNHL.
For this Surveillance, Epidemiology, and End Results (SEER)-Medicare cohort study, we identified 9395 patients with iNHL (follicular, marginal zone, Waldenström macroglobulinemia) treated with chemotherapy from 2006 to 2013. Thirteen percent received bendamustine-containing regimens. We compared baseline characteristics and infection incidence rates between patients treated with and without bendamustine. We conducted multivariate Cox proportional hazards regression (adjusting for demographics, comorbidities, disease and treatment characteristics, risk factors for infection, and antimicrobial prophylaxis) to determine infectious risks associated with bendamustine.
Bendamustine was associated with an increased risk of both common infections such as bacterial pneumonia (hazard ratio [HR], 1.50 [95% confidence interval {CI}, 1.21-4.85]) and opportunistic infections such as cytomegalovirus (HR, 3.98 [95% CI, 1.40-11.26]), varicella zoster virus (HR, 1.49 [95% CI, 1.18-1.89]), histoplasmosis (HR, 3.55 [95% CI, 1.10-11.42]), and Pneumocystis jirovecii pneumonia (when administered as third-line therapy: HR, 3.32 [95% CI, 1.00-11.11]). Risk of infections was more prominent in patients receiving bendamustine as part of later (third-line and above) regimens, and independently associated with well-established factors such as neutropenia and corticosteroid exposure.
Bendamustine is associated with an increased risk of common and opportunistic infections in patients with iNHL. Further prospective investigation into the potential role of antimicrobial prophylaxis is needed in these patients.
苯达莫司汀是一种有效的化疗药物，越来越多地用于治疗惰性非霍奇金淋巴瘤（iNHL）。虽然有效，但它会导致显著的 T 细胞淋巴细胞减少，这可能会增加感染的风险。我们研究了接受含苯达莫司汀方案治疗的老年 iNHL 患者的感染并发症。
这项监测、流行病学和最终结果（SEER）-医疗保险队列研究纳入了 9395 例 2006 年至 2013 年接受化疗治疗的 iNHL（滤泡性、边缘区、华氏巨球蛋白血症）患者。13%的患者接受了含苯达莫司汀的方案。我们比较了接受和未接受苯达莫司汀治疗的患者的基线特征和感染发生率。我们进行了多变量 Cox 比例风险回归（调整了人口统计学、合并症、疾病和治疗特征、感染风险因素以及抗菌预防），以确定与苯达莫司汀相关的感染风险。
苯达莫司汀与常见感染（如细菌性肺炎，风险比[HR]为 1.50[95%置信区间{CI}为 1.21-4.85]）和机会性感染（如巨细胞病毒[HR]为 3.98[95%CI为 1.40-11.26]）、水痘带状疱疹病毒（HR 为 1.49[95%CI 为 1.18-1.89]）、组织胞浆菌病（HR 为 3.55[95%CI 为 1.10-11.42]）和肺孢子虫肺炎（当作为三线治疗时：HR 为 3.32[95%CI 为 1.00-11.11]）的风险增加相关。在接受苯达莫司汀作为三线及以上方案治疗的患者中，感染风险更为显著，并且与中性粒细胞减少和皮质类固醇暴露等已确立的因素独立相关。
苯达莫司汀与 iNHL 患者的常见和机会性感染风险增加相关。需要进一步前瞻性研究这些患者中抗菌预防的潜在作用。
