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EJHaem Pub Date : 2024-12-28 DOI:10.1002/jha2.1070

Laura Schou Pedersen, Nadja Nørholm Klausen, Jonas Faartoft Jensen, Emilis Danielsen Bacevičius, Peter Brown, Judit Mészáros Jørgensen, Thomas Stauffer Larsen, Christian Bjørn Poulsen, Michael Roost Clausen, Robert Schou Pedersen, Anne Ortved Gang, Rasmus Westermann, Salome Kristensen, Lene Wohlfahrt Dreyer, Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen

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引用次数: 0

摘要

背景：对弥漫大B细胞淋巴瘤（DLBCL）治疗后对免疫系统的长期影响了解有限：对弥漫大B细胞淋巴瘤（DLBCL）治疗后对免疫系统的长期影响了解有限：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(R)-CHOP（环磷酰胺、多柔比星、长春新碱、泼尼松龙）类免疫化疗后获得了完全缓解（CR）。每位接受过 R+ CHOP 类治疗的患者都与丹麦背景人群中的五位比较者进行了配对，并与接受过 R- CHOP 类治疗的患者进行了比较。计算了各种感染、自身免疫性疾病和免疫缺陷（AC-IDs）的发病率比（IRRs）和风险差异（RDs），并按亚型进行了分类：R+ CHOP 类治疗患者的总体感染风险（IRR 1.5，95% 置信区间 [CI] 1.4-1.7：10 年 RD 5.0%，95% 置信区间 [CI] 2.2%-7.8%）和大多数亚型的感染风险均高于匹配的比较者。同样，他们患 AC-IDs 的总体风险（IRR 为 1.4，95% CI 为 1.1-1.7；RD 为 0.8%，95% CI 为 0.7%-2.2%）也高于配对比较者，但只有三种亚型具有临床意义：内分泌系统自身免疫性疾病、肉样瘤病和免疫缺陷。与单用 CHOP 类疗法相比，在 CHOP 类疗法中加入利妥昔单抗不会改变感染的总体发病率（IRR）（IRR 1.1，95% CI 0.9-1.3）或 AC-IDs 的总体发病率（IRR 0.8，95% CI 0.5-1.3），但呼吸道感染的 IR 显著升高（IRR 1.5，95% CI 1.1-2.1）。然而，在 R+ CHOP 存活者中观察到 IVIG 治疗的使用增加：结论：与背景人群相比，接受 R-CHOP 类治疗的患者总体上面临感染和 AC-IDs 的风险增加。在 CHOP 中添加利妥昔单抗后，感染和 AC-ID 的风险总体上没有变化，但呼吸道感染的风险显著增加。这些发现可能凸显了提高警惕和采取预防策略的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

The long-term risk of immune-related conditions in survivors of diffuse large B-cell lymphoma: A Danish nationwide registry study

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The long-term risk of immune-related conditions in survivors of diffuse large B-cell lymphoma: A Danish nationwide registry study

Background

There is limited knowledge of the long-term effects on the immune system after treatment for diffuse large B-cell lymphoma (DLBCL).

Methods

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.

Results

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.

Conclusion

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.

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EJHaem

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