Abalo Kossi D, Ekberg Sara, Andersson Therese M L, Pahnke Simon, Albertsson-Lindblad Alexandra, Smedby Karin E, Jerkeman Mats, Glimelius Ingrid
Department of Immunology, Genetics and Pathology, Cancer Precision Medicine Uppsala University Uppsala Sweden.
Department of Medicine Solna, Clinical Epidemiology Division Karolinska Institutet Stockholm Sweden.
Hemasphere. 2024 Jul 8;8(7):e121. doi: 10.1002/hem3.121. eCollection 2024 Jul.
Advancements in treatments have significantly improved the prognosis for mantle cell lymphoma (MCL), and there is a growing population of survivors with an increased susceptibility to infections. We assessed the incidence of infections by clinical characteristics and treatment both before and after MCL diagnosis in Sweden. Patients with a diagnosis of MCL ≥ 18 years between 2007 and 2019 were included, along with up to 10 matched comparators. Infectious disease diagnosis and anti-infective drug dispensation were identified by the National Patient and the Prescribed Drug Registers, respectively. Patients and comparators were followed from the diagnosis/matching date until death, emigration, or June 30, 2020. Overall, 1559 patients and 15,571 comparators were followed for a median duration of 2.9 and 5 years, respectively. The infection rate among patients was twofold higher, RRadj = 2.14 (2.01-2.27), contrasted to the comparator group. There was a notable rise in infection rates already 4 years before MCL diagnosis, which reached a fourfold increase in the first year after diagnosis and persisted significantly increased for an additional 8 years. Among patients, 69% ( = 1080) experienced at least one infection during the first year of follow-up. Influenza, pneumonia, other bacterial infections, urinary tract infections, and acute upper respiratory infections were the most frequent. Notably, MCL remained to be the primary leading cause of death among patients (57%, = 467/817). Infections as the main cause of death were rare (2.6%, = 21). Our study highlights the importance of thoroughly assessing infectious morbidity when appraising new treatments. Further investigations are warranted to explore strategies for reducing infectious disease burden.
治疗方法的进步显著改善了套细胞淋巴瘤（MCL）的预后，并且幸存者群体不断扩大，他们感染的易感性增加。我们根据瑞典MCL诊断前后的临床特征和治疗情况评估了感染发生率。纳入了2007年至2019年间诊断为MCL且年龄≥18岁的患者，以及多达10名匹配的对照者。分别通过国家患者登记册和处方药登记册确定传染病诊断和抗感染药物配给情况。从诊断/匹配日期开始对患者和对照者进行随访，直至死亡、移民或2020年6月30日。总体而言，对1559例患者和15571名对照者进行了随访，中位随访时间分别为2.9年和5年。与对照组相比，患者的感染率高出两倍，调整后的相对危险度（RRadj）=2.14（2.01 - 2.27）。在MCL诊断前4年感染率就显著上升，在诊断后的第一年达到四倍增长，并在接下来的8年中持续显著升高。在患者中，69%（=1080）在随访的第一年至少经历了一次感染。流感、肺炎、其他细菌感染、尿路感染和急性上呼吸道感染最为常见。值得注意的是，MCL仍然是患者死亡的主要首要原因（57%，=467/817）。感染作为主要死亡原因的情况很少见（2.6%，=21）。我们的研究强调了在评估新治疗方法时全面评估感染发病率的重要性。有必要进一步开展研究以探索减轻传染病负担的策略。
