Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.
Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
Transpl Infect Dis. 2020 Aug;22(4):e13292. doi: 10.1111/tid.13292. Epub 2020 Apr 23.
Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear.
The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL.
We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally.
Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group.
The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.
霍奇金（HL）和非霍奇金淋巴瘤（NHL）代表了一系列淋巴细胞恶性肿瘤，目前应用的治疗方案通常可以治愈这些疾病；然而，仍有 15%-30%的淋巴瘤患者患有复发或难治性（rel/ref）疾病。尽管造血干细胞移植（HSCT）改善了儿童二线治疗淋巴瘤的预后，但该组患者的并发症发生率，尤其是感染性并发症（IC），仍不清楚。
本基于人群的队列研究旨在对原发性或 rel/ref 淋巴瘤患者（包括 HL 和 NHL）的细菌性感染（BI）、侵袭性真菌病（IFD）和病毒性感染（VI）的发生率、流行病学和特征进行回顾性分析。
我们将淋巴瘤患者分为三组：接受原发性常规化疗/放疗方案的患者（A 组）、接受二线化疗治疗 rel/ref 淋巴瘤的患者（B 组）和接受 HSCT 的 rel/ref 淋巴瘤患者（C 组）。每个儿科肿瘤中心每两年报告一次患者的病历，然后由中心对数据进行分析。
在 637 例原发性淋巴瘤患者中，255 例（40.0%）至少诊断出 1 次 IC，52 例 rel/ref 淋巴瘤患者中 24 例（46.2%）观察到 IC，移植组 49 例患儿中 28 例（57.1%）诊断为 IC（P=0.151）。IC 的病因分布在患者组（A、B、C）之间存在差异，A 组 BI 占主导地位（85.6%比 72.0%和 47.9%），C 组 VI 占主导地位（9%和 16.0%比 46.6%），B 组 IFD 占主导地位（5.4%比 12.0%和 5.5%）。总的来说，整个组中诊断出 500 例（68.0%）细菌性 IC 发作。除了接受化疗的 HL 患者外，在所有其他亚组患者中，革兰阳性菌均占主导地位。耐多药菌的发生率很高，尤其是革兰氏阴性菌（A 组为 41.1%，B 组为 62.5%，C 组为 84.6%）。各组之间的感染相关死亡率相当。
一线和二线化疗以及 HSCT 后 IC 的发生率相当，但原发性或 rel/ref 淋巴瘤的 IC 特征不同，且取决于治疗类型。
