Mathur S, Christou G, Delage R, Elemary M, Finn N, Geddes M, Houston D S, Keating M M, Khalaf D, Leber B, Leitch H, Lother S A, Mozessohn L, Nevill T, Parmentier A, Paulson K, Rimmer E, Sabloff M, Shamy A, St-Hilaire E, Storring J, Yee K, Zhang L, Zhu N, Hay A E, Zarychanski R, Buckstein R, Houston Brett L
Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
Division of Hematology, The Ottawa Hospital, Ottawa, Canada.
Ann Hematol. 2024 Dec;103(12):5241-5248. doi: 10.1007/s00277-024-06096-x. Epub 2024 Nov 22.
Infections are a significant cause of morbidity and mortality in myelodysplastic syndrome (MDS). Precise estimates of infection frequency and severity with modern therapies are uncertain. We conducted a retrospective analysis of a prospective cohort enrolled in a Canadian MDS registry and characterized the frequency and severity of infectious complications. Among 1,115 patients enrolled in the registry from 2006 to 2022, 349 (31%) experienced fever/infection, 207 (19%) were hospitalized due to fever/infection, and 95 (9%) died from fever/infection. Patients with severe neutropenia (absolute neutrophil count < 0.5 × 10/L) experienced more fever/infection (40% vs. 30%; p = 0.05), shorter time to fever/infection (7 vs. 25 months; p < 0.01) and more hospitalization for fever/infection (9 vs. 27 months; p < 0.01). Higher-risk MDS patients (Revised International Prognostic Scoring System > 3.5) had more fever/infection (36% vs. 29%; p = 0.05), infection-related hospitalizations (24% vs. 14%; p < 0.01), and a trend toward higher mortality due to fever/infection (11% vs. 7%; p = 0.06). Hypomethylating agent (HMA) treatment was associated with higher rates of fever/infection (40% vs. 26%; p < 0.01), as well as increased infection-related hospitalization (27% vs. 14%; p < 0.01) and death (14% vs. 6%; p < 0.01). Multivariate analysis showed that higher-risk disease and HMA treatment contributed to poorer infection-related outcomes including a shorter time from diagnosis to fever/infection (HR 1.9; p < 0.01 and HR 1.8; p < 0.01, respectively), hospitalization (HR 2.5; p < 0.01 and HR 1.9; p < 0.01, respectively), and death (HR 2.3; p = 0.01 and HR 3.3; p < 0.01, respectively). In a Canadian MDS population, infectious events were common with baseline neutropenia, higher-risk disease, and hypomethylating agents associated with increased infection risk.
感染是骨髓增生异常综合征（MDS）发病和死亡的重要原因。现代疗法下感染频率和严重程度的精确估计尚不确定。我们对纳入加拿大MDS登记处的前瞻性队列进行了回顾性分析，并对感染并发症的频率和严重程度进行了特征描述。在2006年至2022年登记的1115例患者中，349例（31%）出现发热/感染，207例（19%）因发热/感染住院，95例（9%）死于发热/感染。严重中性粒细胞减少（绝对中性粒细胞计数<0.5×10⁹/L）的患者发热/感染更多（40%对30%；p=0.05），发热/感染的时间更短（7个月对25个月；p<0.01），因发热/感染住院更多（9个月对27个月；p<0.01）。高危MDS患者（修订后的国际预后评分系统>3.5）发热/感染更多（36%对29%；p=0.05），与感染相关的住院更多（24%对14%；p<0.01），且因发热/感染导致的死亡率有升高趋势（11%对7%；p=0.06）。去甲基化药物（HMA）治疗与更高的发热/感染率（40%对26%；p<0.01）、感染相关住院增加（27%对14%；p<0.01）和死亡增加（14%对6%；p<0.01）相关。多变量分析显示，高危疾病和HMA治疗导致感染相关结局更差，包括从诊断到发热/感染的时间更短（风险比1.9；p<0.01和风险比1.8；p<0.01）、住院（风险比2.5；p<0.01和风险比1.9；p<0.01）和死亡（风险比2.3；p=0.01和风险比3.3；p<0.01）。在加拿大MDS人群中，感染事件很常见，基线中性粒细胞减少、高危疾病和去甲基化药物与感染风险增加相关。
