Zadro Yoann, Lafaurie Margaux, Michel Marc, Lapeyre-Mestre Maryse, Moulis Guillaume
Department of Internal Medicine, Toulouse University Hospital, Toulouse University, Toulouse, France.
Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse University, Toulouse, France.
Blood Adv. 2025 Jan 14;9(1):231-238. doi: 10.1182/bloodadvances.2024013067.
Autoimmune hemolytic anemia (AIHA) is a rare and sometimes life-threatening disease. Infections are frequent and often severe during the course of AIHA. Rituximab is commonly used to treat patients with AIHA. This study aimed to assess the risk of hospitalization with infection after rituximab in patients with primary AIHA. We selected all adult patients newly diagnosed for primary AIHA and treated with rituximab between 2012 and 2018 in the French national health database. Patients were considered exposed to rituximab within 6 months after the first infusion. The main outcome was hospitalization with infection, identified by a discharge diagnosis of infection during the rituximab exposure. The cohort consisted of 959 patients (mean age of 67 years, standard deviation of 17.8 years; 60.5% of women). The 6-month cumulative incidence of hospitalization with infection was 17.6% (95% confidence interval [CI], 15.2-20.0). The most frequently characterized infections were pulmonary (40.2%). Opportunistic infections were observed in 28 (16.6%) patients, including 11 cases of pneumocystosis. All cases of pneumocystosis occurred in patients concomitantly exposed to corticosteroids, none of them had prophylaxis and all but 2 were aged ≥70 years. Overall, the main factors associated with hospitalization with infection were an age ≥70 years and the exposure to corticosteroids. The 30-day overall mortality after hospitalization with infection was 12.5% (95% CI, 8.0-18.0). In conclusion, the incidence of hospitalizations with infection, including opportunistic infections, as well as the subsequent mortality, are high in adult patients with primary AIHA treated with rituximab. Pneumocystosis prophylaxis should be encouraged in older patients exposed to corticosteroids.
自身免疫性溶血性贫血（AIHA）是一种罕见且有时会危及生命的疾病。在AIHA病程中，感染很常见且往往较为严重。利妥昔单抗常用于治疗AIHA患者。本研究旨在评估原发性AIHA患者接受利妥昔单抗治疗后因感染住院的风险。我们在法国国家卫生数据库中选取了2012年至2018年间所有新诊断为原发性AIHA并接受利妥昔单抗治疗的成年患者。患者在首次输注后6个月内被视为暴露于利妥昔单抗。主要结局是因感染住院，通过利妥昔单抗暴露期间的出院诊断感染来确定。该队列由959名患者组成（平均年龄67岁，标准差17.8岁；60.5%为女性）。6个月内因感染住院的累积发生率为17.6%（95%置信区间[CI]，15.2 - 20.0）。最常见的感染类型是肺部感染（40.2%）。28例（16.6%）患者出现机会性感染，包括11例肺孢子菌病。所有肺孢子菌病病例均发生在同时暴露于糖皮质激素的患者中，他们均未接受预防措施，除2例患者外，其余患者年龄均≥70岁。总体而言，与因感染住院相关的主要因素是年龄≥70岁以及暴露于糖皮质激素。感染住院后30天的总体死亡率为12.5%（95% CI，8.0 - 18.0）。总之，接受利妥昔单抗治疗的成年原发性AIHA患者因感染（包括机会性感染）住院的发生率以及随后的死亡率都很高。应鼓励对暴露于糖皮质激素的老年患者进行肺孢子菌病预防。
