Liu Dan, Yin Xia, Wang Hui, Xing Lijie, Li Ping, Wei Haichen, Ma Ji, He Qiang, Xie Linna, Lu Ke, Li Zengjun
Department of Lymphoma, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Front Oncol. 2025 Jan 6;14:1504809. doi: 10.3389/fonc.2024.1504809. eCollection 2024.
Patients with hematological malignancies have an elevated risk of developing pneumonia after contracting COVID-19. Lymphoma is the most prevalent hematologic malignancy. It is critical to identify patients at high risk of contracting COVID-19-associated pneumonia.
From January 11-31, 2023, we distributed questionnaires to patients diagnosed with lymphoma according to 2016 World Health Organization diagnostic and classification criteria. COVID-19 infection was confirmed based on symptoms and laboratory tests. Pneumonia was confirmed using computed tomography scans.
In total, 257 patients were included in this study; 221 patients (86.0%) had COVID-19 infection and 61 (27.6%) of these had pneumonia. Patients with B-cell non-Hodgkin lymphoma (B-NHL) had a significantly higher pneumonia incidence than patients with other lymphoma types (31.8% vs. 27.6%, P=0.005). Higher incidence of pneumonia was observed in patients receiving anti-CD20 therapy (30.0% vs. 16.3%, P=0.048) and Bruton's tyrosine kinase (BTK) inhibitor therapy (51.3% vs. 22.5%, P=0.001). B-NHL (hazard ratio [HR]=3.7, 95% confidence interval [CI] 1.4-10.0, P=0.009), anti-CD20 therapy (HR=2.3, 95% CI 1.0-5.2, P=0.050), BTK inhibitor (HR=3.6, 95% CI 1.8-7.4, P<0.001), active therapy (HR=3.0, 95% CI 1.5-5.7, P=0.001), and lack of disease remission (HR=3.7, 95% CI 1.8-7.4, P=0.001) were high-risk factors for developing pneumonia. Anti-PD-1 therapy was a protective factor against pneumonia development (HR=0.2, 95% CI 0.05-0.9, P=0.034). In multivariable analysis, BTK inhibitor (HR=3.5, 95% CI 1.6-8.0, P=0.003), active therapy (HR=3.3, 95% CI 1.6-6.8, P=0.001), and disease non-remission (HR=2.9, 1.3-6.4, P=0.007) were independent risk factors for pneumonia development after COVID-19 infection in patients with lymphoma.
Patients with lymphoma receiving BTK inhibitors, undergoing active therapy, and lacking disease remission exhibited a higher risk for pneumonia associated with COVID-19.
血液系统恶性肿瘤患者感染新型冠状病毒肺炎（COVID-19）后发生肺炎的风险升高。淋巴瘤是最常见的血液系统恶性肿瘤。识别感染COVID-19相关肺炎的高危患者至关重要。
2023年1月11日至31日，我们根据2016年世界卫生组织诊断和分类标准，向诊断为淋巴瘤的患者发放问卷。根据症状和实验室检查确诊COVID-19感染。使用计算机断层扫描确诊肺炎。
本研究共纳入257例患者；221例（86.0%）患者感染了COVID-19，其中61例（27.6%）发生了肺炎。B细胞非霍奇金淋巴瘤（B-NHL）患者的肺炎发病率显著高于其他淋巴瘤类型患者（31.8%对27.6%，P=0.005）。接受抗CD20治疗（30.0%对16.3%，P=0.048）和布鲁顿酪氨酸激酶（BTK）抑制剂治疗（51.3%对22.5%，P=0.001）的患者肺炎发病率较高。B-NHL（风险比[HR]=3.7，95%置信区间[CI]1.4-10.0，P=0.009）、抗CD20治疗（HR=2.3，95%CI 1.0-5.2，P=0.050）、BTK抑制剂（HR=3.6，95%CI 1.8-7.4，P<0.001）、积极治疗（HR=3.0，95%CI 1.5-5.7，P=0.001）和疾病未缓解（HR=3.7，95%CI 1.8-7.4，P=0.001）是发生肺炎的高危因素。抗PD-1治疗是预防肺炎发生的保护因素（HR=0.2，95%CI 0.05-0.9，P=0.034）。在多变量分析中，BTK抑制剂（HR=3.5，95%CI 1.6-8.0，P=0.003）、积极治疗（HR=3.3，95%CI 1.6-6.8，P=0.001）和疾病未缓解（HR=2.9，1.3-6.4，P=0.007）是淋巴瘤患者感染COVID-19后发生肺炎的独立危险因素。
接受BTK抑制剂治疗、正在接受积极治疗且疾病未缓解的淋巴瘤患者发生与COVID-19相关肺炎的风险较高。
