弥漫性大 B 细胞淋巴瘤患者经 R-CHOP 治疗后并发肺孢子菌肺炎。

Pneumocystis jirovecii pneumonia in diffuse large B-cell Lymphoma treated with R-CHOP.

机构信息

Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

出版信息

Mycoses. 2021 Jan;64(1):60-65. doi: 10.1111/myc.13184. Epub 2020 Oct 28.

DOI:10.1111/myc.13184

PMID:32970331

Abstract

BACKGROUND

The aim of this study was to estimate the incidence of and risk factors for Pneumocystis pneumonia (PCP) infection in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP).

METHODS

The medical records of 739 DLBCL patients who received R-CHOP between May 2004 and January 2019 were retrospectively evaluated. Patients were divided into two groups: those who received primary PCP prophylaxis (prophylaxis group) and those who did not (control group). The incidence rate of PCP in each group was calculated, and risk factors for PCP were evaluated in the control group.

RESULTS

Baseline characteristics were significantly different between the two groups. Compared to the 602 patients who did not receive prophylaxis, the prophylaxis group (n = 137) had poor prognostic factors of older age, high lactate dehydrogenase (LDH) levels, advanced Ann Arbour stage, and high International Prognostic Index (IPI) risk scores. None of the patients receiving PCP prophylaxis developed PCP, while the incidence of PCP in the control group was 8.1% (definite cases 5.5% and probable cases 2.7%). Out of the 49 patients who developed PCP, 10 patients (20.4%) were admitted to the intensive care unit, and the PCP-related death rate was 16.3% (8/49).

CONCLUSION

This study showed that PCP prophylaxis is highly effective against PCP infection and may help guide prevention of PCP during R-CHOP treatment in DLBCL patients.

摘要

背景

本研究旨在评估利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）治疗弥漫性大 B 细胞淋巴瘤（DLBCL）患者中发生肺囊虫肺炎（PCP）感染的发病率和危险因素。

方法

回顾性分析了 2004 年 5 月至 2019 年 1 月期间接受 R-CHOP 治疗的 739 例 DLBCL 患者的病历。患者分为两组：接受初始 PCP 预防治疗（预防组）和未接受预防治疗（对照组）。计算每组 PCP 的发生率，并在对照组中评估 PCP 的危险因素。

结果

两组患者的基线特征存在显著差异。与未接受预防治疗的 602 例患者相比，预防组（n=137）患者年龄较大、乳酸脱氢酶（LDH）水平较高、Ann Arbor 分期较晚、国际预后指数（IPI）风险评分较高，这些均为不良预后因素。接受 PCP 预防治疗的患者无一例发生 PCP，而对照组的 PCP 发生率为 8.1%（明确诊断为 5.5%，可能诊断为 2.7%）。在发生 PCP 的 49 例患者中，有 10 例（20.4%）患者入住重症监护病房，PCP 相关死亡率为 16.3%（8/49）。