Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.
Eur J Haematol. 2021 Mar;106(3):346-353. doi: 10.1111/ejh.13553. Epub 2020 Dec 3.
Opportunistic infections in chronic lymphocytic leukemia (CLL) have been described in clinical trials, single-center studies, and case reports. We performed a nationwide study to estimate the incidence and impact of inpatient opportunistic infections.
The incidence rate (IR) and incidence rate ratio (IRR) for Swedish CLL patients diagnosed 1994-2013, and matched controls were calculated, as well as the case-fatality ratio (CFR).
Among 8989 CLL patients, a total of 829 opportunistic infections were registered (IR 16.6 per 1000 person-years) compared with 252 opportunistic infections in 34 283 matched controls (IR 0.99). The highest incidence in the CLL cohort was for Pneumocystis pneumonia (200 infections, IR 4.03); Herpes zoster (146 infections, IR 2.94), and Pseudomonas (83 infections, IR 1.66) infections. The highest risk relative to matched controls was observed for Pneumocystis pneumonia (IRR 114, 95% confidence interval 58.7-252). The 60-day CFR for CLL patients with opportunistic infections was 23% (188/821), highest for progressive multifocal encephalopathy (5/7, 71%) and aspergillosis (25/60, 42%).
We have uniquely depicted the incidence of rare and serious infections in CLL patients and found a relatively high incidence of Pneumocystis pneumonia. Of the most common opportunistic infections, CLL patients with aspergillosis had the poorest prognosis.
慢性淋巴细胞白血病（CLL）的机会性感染已在临床试验、单中心研究和病例报告中描述。我们进行了一项全国性研究，以估计住院机会性感染的发病率和影响。
计算了 1994-2013 年诊断的瑞典 CLL 患者和匹配对照的发病率（IR）和发病率比（IRR），以及病死率（CFR）。
在 8989 例 CLL 患者中，共登记了 829 例机会性感染（IR 为 16.6/1000 人年），而 34283 例匹配对照中仅登记了 252 例机会性感染（IR 为 0.99）。CLL 队列中发病率最高的是肺囊虫肺炎（200 例感染，IR 为 4.03）；带状疱疹（146 例感染，IR 为 2.94）和假单胞菌（83 例感染，IR 为 1.66）感染。与匹配对照相比，肺囊虫肺炎的风险最高（IRR 114，95%置信区间 58.7-252）。发生机会性感染的 CLL 患者的 60 天 CFR 为 23%（188/821），最高的是进行性多灶性白质脑病（5/7，71%）和曲霉病（25/60，42%）。
我们独特地描述了 CLL 患者罕见和严重感染的发病率，并发现肺囊虫肺炎的发病率相对较高。在最常见的机会性感染中，曲霉病的 CLL 患者预后最差。
