Pedersen Laura Schou, Klausen Nadja Nørholm, Jensen Jonas Faartoft, Bacevičius Emilis Danielsen, Brown Peter, Mészáros Jørgensen Judit, Larsen Thomas Stauffer, Poulsen Christian Bjørn, Clausen Michael Roost, Schou Pedersen Robert, Gang Anne Ortved, Westermann Rasmus, Kristensen Salome, Dreyer Lene Wohlfahrt, El-Galaly Tarec Christoffer, Jakobsen Lasse Hjort
Department of Haematology, Clinical Cancer Research Center Aalborg University Hospital Aalborg Denmark.
Department of Haematology Rigshospitalet Copenhagen Denmark.
EJHaem. 2024 Dec 28;6(1):e1070. doi: 10.1002/jha2.1070. eCollection 2025 Feb.
There is limited knowledge of the long-term effects on the immune system after treatment for diffuse large B-cell lymphoma (DLBCL).
This study included DLBCL patients from the Danish Lymphoma Registry who obtained complete remission (CR) after (R)-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone)-like immunochemotherapy. Each R CHOP-like treated patient was matched to five comparators from the Danish background population and furthermore compared to R CHOP-like treated patients. Incidence rate ratios (IRRs) and risk differences (RDs) were calculated for a wide range of infections, autoimmune conditions, and immune deficiencies (AC-IDs) combined and by subtypes.
R CHOP-like treated patients had a higher risk of infections overall (IRR 1.5, 95% confidence interval [CI] 1.4-1.7: 10-year RD 5.0%, 95% CI 2.2%-7.8%) and for a majority of the subtypes than matched comparators. Likewise, they had a higher risk of AC-IDs overall (IRR 1.4, 95% CI 1.1-1.7; RD 0.8%, 95% CI 0.7%-2.2%) than matched comparators, however only of clinical relevance for three subtypes; autoimmune diseases of the endocrine system, sarcoidosis and immune deficiencies. The addition of rituximab to CHOP-like therapy did not alter the incidence rates (IR) of infections overall (IRR 1.1, 95% CI 0.9-1.3) or AC-IDs overall (IRR 0.8, 95% CI 0.5-1.3) compared to CHOP-like therapy alone, although the IR for respiratory infections was significantly elevated (IRR 1.5, 95% CI 1.1-2.1). However, an increased use of IVIG treatment was observed among R CHOP survivors.
R-CHOP-like treated patients face an increased risk of infections and AC-IDs overall compared with the background population. The risk of infections and AC-IDs did not change overall after the addition of rituximab to CHOP, however, an increased risk of respiratory infections is notable. These findings could highlight the need for expanded vigilance and prophylaxis strategies.
对于弥漫性大B细胞淋巴瘤（DLBCL）治疗后对免疫系统的长期影响，人们了解有限。
本研究纳入了丹麦淋巴瘤登记处的DLBCL患者，这些患者在接受类似（R）-CHOP（环磷酰胺、阿霉素、长春新碱、泼尼松龙）的免疫化疗后获得完全缓解（CR）。每例接受类似R-CHOP治疗的患者与来自丹麦背景人群的五名对照者进行匹配，并进一步与接受类似R-CHOP治疗的患者进行比较。计算了广泛的感染、自身免疫性疾病和免疫缺陷（AC-ID）合并症及各亚型的发病率比（IRR）和风险差异（RD）。
总体而言，接受类似R-CHOP治疗的患者发生感染的风险更高（IRR 1.5，95%置信区间[CI] 1.4 - 1.7；10年RD 5.0%，95% CI 2.2% - 7.8%），且大多数亚型的感染风险高于匹配的对照者。同样，他们发生AC-ID的总体风险也高于匹配的对照者（IRR 1.4，95% CI 1.1 - 1.7；RD 0.8%，95% CI 0.7% - 2.2%），不过仅三种亚型具有临床相关性；内分泌系统自身免疫性疾病、结节病和免疫缺陷。与单独使用类似CHOP的疗法相比，在类似CHOP的疗法中添加利妥昔单抗并未改变总体感染发病率（IRR 1.1，95% CI 0.9 - 1.3）或总体AC-ID发病率（IRR 0.8，95% CI 0.5 - 1.3），尽管呼吸道感染的IR显著升高（IRR 1.5，95% CI 1.1 - 2.1）。然而，在接受R-CHOP治疗的幸存者中观察到静脉注射免疫球蛋白治疗的使用增加。
与背景人群相比，接受类似R-CHOP治疗的患者总体上面临感染和AC-ID风险增加。在CHOP中添加利妥昔单抗后，感染和AC-ID的总体风险并未改变，然而，呼吸道感染风险增加值得关注。这些发现可能凸显了扩大监测和预防策略的必要性。
