Nilesh Kapoor, Qiuhong Zhao, Andrew Stiff, Seema A. Bhat, Mirela I. Anghelina, Leslie A. Andritsos, James S. Blachly, Narendranath Epperla, Zeinab El Boghdadly, Michael R. Grever, Kerry A. Rogers
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引用次数: 0
摘要
毛细胞白血病是一种不常见的 B 细胞恶性肿瘤,对嘌呤类似物以及伊布替尼和维莫非尼等靶向疗法反应良好。然而,众所周知,嘌呤类似物具有高度免疫抑制作用,目前的疗法对这一患者群体造成的感染负担尚不清楚。因此,我们对 149 名患者进行了回顾性队列研究。中位随访时间为 6.9 年。36%的患者发生了需要住院治疗的机会性感染或严重感染。大多数病例为细菌感染,且大多伴有中性粒细胞减少和/或CD4 T淋巴细胞减少。没有一种治疗药物与感染发生率的增减有明显关联。令人欣慰的是,感染的累积发生率在初始治疗2个月后趋于平稳,这表明临床上的免疫功能明显恢复。在我们的队列中,只有一名患者因感染而去世。估计的10年总生存率为99%,这表明感染可能不会像目前的疗法之前那样导致大量死亡。
Incidence, description, and timing of serious and opportunistic infections in patients with hairy cell leukemia
Hairy cell leukemia is an uncommon B-cell malignancy with excellent response to purine analogs and to targeted therapies such as ibrutinib and vemurafenib. However, purine analogs are known to be highly immunosuppressive and the infection burden in this patient population with current therapies is unknown. We therefore conducted a retrospective cohort study following 149 patients. Median follow-up time was 6.9 years. Thirty-six percent developed an opportunistic or serious infection requiring hospitalization. Most cases were bacterial and most coincided with neutropenia and/or CD4 T-lymphopenia. No single treatment agent was significantly associated with increased or decreased incidence of infection. Reassuringly, the cumulative incidence of infections plateaued 2 months after initial treatment suggesting clinically significant immune recovery. Only one patient in our cohort passed away due to infection. Estimated 10-year overall survival was 99% suggesting that infections may not cause as much mortality as was seen prior to current therapies.