Severinsen Freja Tang, Simonsen Mikkel Runason, Futtrup Maksten Eva, Jakobsen Lasse Hjort, Jensen Rasmus Kuhr, Søgaard Kirstine Kobberøe, Jensen Paw, Brown Peter de Nully, Mészáros Jørgensen Judit, Larsen Thomas Stauffer, Poulsen Christian Bjørn, El-Galaly Tarec Christoffer
Department of Hematology, Clinical Cancer Research Center Aalborg, Aalborg University Hospital, Aalborg, Denmark.
Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark.
Br J Haematol. 2025 Sep;207(3):920-928. doi: 10.1111/bjh.20262. Epub 2025 Jul 13.
Infectious complications after high-dose therapy and autologous stem cell transplantation (HDT-ASCT) for lymphoma are the leading cause of late non-relapse mortality. Characterizing the risk of infectious complications over time is important for rational follow-up and because alternatives to HDT-ASCT exist for some patients. This national cohort study investigated the risk of severe (defined by requiring hospitalization) late infections after 90 days among HDT-ASCT-treated patients with lymphoma in remission relative to the Danish background population (comparators) matched on age, sex and comorbidity score. Anti-cancer treatment after HDT-ASCT and death were competing events. This study included 781 patients and 3905 comparators. With a median follow-up of 7.7 years for patients, the incidence rate ratios of severe infections from 90 days until 2 years after HDT-ASCT was 8.43 (95% confidence interval (CI): 6.98-10.16) and the 2-year cumulative risk was 23.7% (95% CI: 20.7%-26.7%) for patients and 3.4% (95% CI: 2.9%-4.0%) for comparators. The risk of severe infections remained increased for up to 10 years after HDT-ASCT. Respiratory tract infections were the most frequent type, with a 2-year cumulative risk difference of 10.9% (95% CI: 8.6%-13.3%). Patients were more likely to be prescribed anti-infectives, including broad-spectrum antibiotics 5-10 years after HDT-ASCT.
淋巴瘤大剂量治疗及自体干细胞移植（HDT-ASCT）后的感染并发症是晚期非复发死亡率的主要原因。随着时间推移对感染并发症风险进行特征描述对于合理的随访很重要，而且因为对于一些患者存在HDT-ASCT的替代方案。这项全国队列研究调查了缓解期接受HDT-ASCT治疗的淋巴瘤患者相对于按年龄、性别和合并症评分匹配的丹麦背景人群（对照者）在90天后发生严重（定义为需要住院）晚期感染的风险。HDT-ASCT后的抗癌治疗和死亡为竞争事件。本研究纳入了781例患者和3905例对照者。患者的中位随访时间为7.7年，HDT-ASCT后90天至2年严重感染的发病率比为8.43（95%置信区间（CI）：6.98 - 10.16），患者的2年累积风险为23.7%（95%CI：20.7% - 26.7%），对照者为3.4%（95%CI：2.9% - 4.0%）。HDT-ASCT后长达10年严重感染风险仍持续增加。呼吸道感染是最常见的类型，2年累积风险差异为10.9%（95%CI：8.6% - 13.3%）。HDT-ASCT后5 - 10年患者更有可能被开具抗感染药物，包括广谱抗生素。
