Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Clin Infect Dis. 2021 Feb 1;72(3):463-471. doi: 10.1093/cid/ciaa090.
Patients with hematological malignancies (HM) are known to carry an increased risk of invasive pneumococcal disease (IPD). However, temporal variations in IPD risks following a cancer diagnosis remain poorly characterized. To inform vaccine guidelines and patient management, we assessed the IPD incidence among patients with HM and other malignancies.
The study population included all individuals aged ≥15 years during 2000-2016 in Denmark. Variations in incidences of IPD over time and between different types of hematological malignancies and diagnoses were assessed by Poisson regression.
During 85 002 224 person-years of observation, 13 332 episodes of a first IPD were observed, of which 765 (5.7%) occurred among individuals with HM. Among HM patients, the IPD incidence rate decreased continuously during the study period (rate ratio per year, 0.91; 95% confidence interval, .90-.92). The risk of IPD in patients with HM was up to 39 times higher when compared to the background population and was highest for multiple myeloma, acute lymphoblastic leukemia, and chronic lymphocytic leukemia. Unlike other malignancies, the increased IPD risk did not wane with the time since HM diagnosis. We found a vaccination uptake of only ≤2% in patients with HM and ≤1% for those with other types of malignancies.
Adults with HM in general and patients with lymphoid malignancies in particular have an increased risk for IPD, compared with patients with other types of cancer and with individuals free of cancer. The pneumococcal vaccination uptake is extremely low in this at risk-population. Efforts to prevent IPD in HM patients are continuously warranted.
患有血液恶性肿瘤（HM）的患者已知存在侵袭性肺炎球菌病（IPD）的风险增加。然而，癌症诊断后 IPD 风险的时间变化仍描述不足。为了为疫苗指南和患者管理提供信息，我们评估了 HM 患者和其他恶性肿瘤患者的 IPD 发病率。
研究人群包括 2000-2016 年期间丹麦所有年龄≥15 岁的个体。通过泊松回归评估随时间和不同类型的血液恶性肿瘤和诊断的 IPD 发生率变化。
在 85002224 人年的观察期间，观察到 13332 例首次 IPD 发作，其中 765 例（5.7%）发生在 HM 患者中。在 HM 患者中，研究期间 IPD 发病率持续下降（每年发病率比，0.91；95%置信区间，0.90-0.92）。与普通人群相比，HM 患者的 IPD 风险高达 39 倍，在多发性骨髓瘤、急性淋巴细胞白血病和慢性淋巴细胞白血病中风险最高。与其他恶性肿瘤不同，HM 诊断后时间的长短并不影响 IPD 风险的降低。我们发现 HM 患者的疫苗接种率仅为≤2%，其他类型恶性肿瘤患者的疫苗接种率为≤1%。
与其他类型癌症患者和无癌症个体相比，一般 HM 患者，特别是淋巴恶性肿瘤患者，发生 IPD 的风险增加。该高危人群的肺炎球菌疫苗接种率极低。需要不断努力预防 HM 患者的 IPD。
