在接受全剂量或减剂量 R-CHOP 治疗的老年弥漫性大 B 细胞淋巴瘤患者中，感染相关发病率和死亡率。

Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP.

机构信息

Department of Haematology, Churchill Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom.

Cancer Research UK and University College London (UCL) Cancer Trials Centre, UCL Cancer Institute, UCL, London, United Kingdom.

出版信息

Blood Adv. 2021 Apr 27;5(8):2229-2236. doi: 10.1182/bloodadvances.2021004286.

DOI:10.1182/bloodadvances.2021004286

PMID:33890978

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8095135/

Abstract

Infection-related morbidity and mortality are increased in older patients with diffuse large B-cell lymphoma (DLBCL) compared with population-matched controls. Key predictive factors for infection-related hospitalization during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and deaths as a result of infection in older patients during and after treatment with R-CHOP remain incompletely understood. For this study, 690 consecutively treated patients age 70 years or older who received full-dose or attenuated-dose R-CHOP treatment were analyzed for risk of infection-related hospitalization and infection-related death. Median age was 77 years, and 34.4% were 80 years old or older. Median follow-up was 2.8 years (range, 0.4-8.9 years). Patient and baseline disease characteristics were assessed in addition to intended dose intensity (IDI). Of all patients, 72% were not hospitalized with infection. In 331 patients receiving an IDI ≥80%, 33% were hospitalized with ≥1 infections compared with 23.3% of 355 patients receiving an IDI of <80% (odds ratio, 1.61; 95% confidence interval, 1.15-2.25; P = .006). An increased risk of infection-related admission was independently associated with IDI >80% across the whole cohort. Primary quinolone prophylaxis independently reduced infection-related admission. A total of 51 patients died as a result of infection. The 6-month, 12-month, 2-year, and 5-year cumulative incidences of infection-related death were 3.3%, 5.0%, 7.2%, and 11.1%, respectively. Key independent factors associated with infection-related death were an International Prognostic Index (IPI) score of 3 to 5, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score ≥6, and low albumin, which enabled us to generate a predictive risk score. We defined a smaller group (15%) of patients (IPI score of 0-2, albumin >36 g/L, CIRS-G score <6) in which no cases of infection-related deaths occurred at 5 years of follow-up. Whether patients at higher risk of infection-related death could be targeted with enhanced antimicrobial prophylaxis remains unknown and will require a randomized trial.

摘要

与匹配人群对照相比，弥漫性大 B 细胞淋巴瘤（DLBCL）老年患者的感染相关发病率和死亡率增加。在接受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）治疗期间，与感染相关的住院治疗以及在接受 R-CHOP 治疗期间和之后因感染导致的死亡的关键预测因素，对于年龄较大的患者而言，仍不完全清楚。在这项研究中，对 690 名连续接受治疗、年龄 70 岁或以上、接受全剂量或减剂量 R-CHOP 治疗的患者进行了分析，以评估与感染相关的住院治疗和与感染相关的死亡风险。中位年龄为 77 岁，34.4%的患者年龄在 80 岁或以上。中位随访时间为 2.8 年（范围，0.4-8.9 年）。除了计划剂量强度（IDI）外，还评估了患者和基线疾病特征。在所有患者中，有 72%没有因感染住院。在 331 名接受 IDI≥80%的患者中，有 33%的患者因感染住院 1 次或多次，而在 355 名接受 IDI＜80%的患者中，有 23.3%的患者因感染住院（比值比，1.61；95%置信区间，1.15-2.25；P=0.006）。在整个队列中，IDI＞80%与感染相关的住院风险增加独立相关。原发性喹诺酮类药物预防治疗可独立降低感染相关的住院率。共有 51 名患者因感染而死亡。6 个月、12 个月、2 年和 5 年时感染相关死亡的累积发生率分别为 3.3%、5.0%、7.2%和 11.1%。与感染相关死亡相关的关键独立因素是国际预后指数（IPI）评分 3-5 分、累积疾病严重程度评分-老年版（CIRS-G）评分≥6 分和低白蛋白，这使我们能够生成一个预测风险评分。我们定义了一个较小的患者组（15%）（IPI 评分 0-2 分、白蛋白＞36g/L、CIRS-G 评分＜6 分），在该组中，5 年随访期间没有发生与感染相关的死亡。是否可以对感染相关死亡风险较高的患者进行强化抗菌预防治疗，仍不清楚，需要进行随机试验。