Infection profiles of different chemotherapy regimens and the clinical feasibility of antimicrobial prophylaxis in patients with DLBCL

The role of the gut microbiota in infectious complications during immunochemotherapy for diffuse large B-cell lymphoma

BACKGROUND

Infections are common complications and causes of death during immunochemotherapy in diffuse large B-cell lymphoma (DLBCL). The gut microbiota plays a significant role in bacterial infection, but its relationship and predictive capacity with infectious complications in DLBCL are unknown.

METHODS

We performed 16S rRNA gene sequencing of fecal samples collected from 41 patients with newly diagnosed DLBCL at baseline, after every two cycles of standard immunochemotherapy, during infection, and after infection recovery. Analysis of the diversity and species composition of these samples was used to evaluate the relationship between gut microbiota and bacterial infection.

RESULTS

Our findings demonstrate the dynamic changes of Enterobacteriaceae in patients with DLBCL during immunochemotherapy. The abundance of Enterobacteriaceae was markedly higher at baseline in patients who subsequently developed bacterial infection during immunochemotherapy than in those who did not (P < 0.0001), and showed a further increase during infection (P < 0.01), after recovery from the infection, the Enterobacteriaceae was significantly decreased (P < 0.001). While there was no significant change in patients who did not develop bacterial infection. The univariate and multivariate analysis showed that baseline abundance of Enterobacteriaceae > 4.5% was independently associated with post-immunochemotherapy bacterial infection.

CONCLUSIONS

Our findings suggest that the gut microbiota signatures differ between patients with DLBCL who do and do not develop bacterial infection. The baseline abundance of Enterobacteriaceae is associated with the post-immunochemotherapy bacterial infection, and it has certain predictive value. Detecting the changes of gut microbiota can help predict the risk of bacterial infection after immunochemotherapy.

Quimioterapia en linfoma y su estrecha relación con el virus de la inmunodeficiencia humana /síndrome de inmunodeficiencia adquirida

El virus de la inmunodeficiencia humana (VIH) ha estado en nuestra sociedad durante muchos años y los casos han aumentado con el paso del tiempo. La inmunosupresión y el síndrome de inmunodeficiencia adquirida (SIA) predisponen en gran parte al desarrollo de diferentes enfermedades, como el linfoma. Objetivo: realizar una revisión acerca de la quimioterapia en el linfoma asociado con el virus de la inmunodeficiencia humana y el síndrome de inmunodeficiencia adquirida, y su predisposición a sufrir más enfermedades oportunistas. Métodos: se realizó una revisión de la literatura en las bases de datos PubMed y ScienceDirect, con los descriptores “infecciones”, “linfoma”, “neoplasias”, “quimioterapia”, “serodiagnóstico del SIDA”, en inglés y español, seleccionando 10 artículos relacionados. Conclusión: la inmunosupresión que genera este virus puede predisponer en gran medida al desarrollo de muchas neoplasias en especial el linfoma. A pesar de que la quimioterapia es el tratamiento más efectivo en este tipo de pacientes, exacerba la condición de base de las personas y los hace más susceptibles a padecer infecciones oportunistas, las cuales pueden empeorar su situación, considerando así la quimioterapia como un factor de riesgo.

Clinical entity of cytomegalovirus disease in patients with malignant lymphoma on bendamustine therapy: a single-institution experience

We investigated the incidence, risk factors, and clinical outcomes of cytomegalovirus (CMV) disease in patients with B-cell lymphoma treated with a bendamustine-containing regimen. The incidence of CMV disease was analyzed after starting treatment with 139 regimens in 126 patients. Clinically significant CMV disease was observed in seven patients. The median duration between bendamustine initiation and the diagnosis of CMV disease was 69 d (range, 40-233), and the median of cycles completed at onset was 2 (range, 1-6). Furthermore, the incidence of CMV disease was significantly higher in the elderly patients than that in the younger patients. The target organs of CMV disease were the liver, gastrointestinal tract, lungs, and retinas. Antiviral therapy was administered to all patients. However, the recurrence of CMV disease was observed in two patients. This study provides information that could contribute to clinicians' decision-making on lymphoma therapy using bendamustine.

Post-chemotherapy pneumonia in Chinese patients with diffuse large B-cell lymphoma: Outcomes and predictive model

Pulmonary infections account for a large proportion of life-threatening adverse events that occur after chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL); however, data on their influencing risk factors and the effects of infection are relatively limited. A total of 605 patients with DLBCL were newly diagnosed at our institution between March 2009 and April 2017, and 132 of these patients developed pneumonia after treatment (21.8%). There was a significant difference in overall survival (OS) between the pneumonia and non-pneumonia groups (hazard ratio 4.819, 95% confidence interval: 3.109–7.470, p < 0.0001), with 5-year OS of 41% and 82%, respectively. Pulmonary involvement, Eastern Cooperative Oncology Group score > 1, and hypoalbuminemia were identified as independent risk factors for the development of pneumonia. We constructed a prediction model based on these three factors, and the area under the curve was 0.7083, indicating good discrimination. This model may help clinicians develop individualized strategies for preventing and treating post-chemotherapy pneumonia in patients with DLBCL.

Early versus delayed debridement for surgical site infection after oncological neurosurgery

Background:

There are no guidelines on the management of surgical site infection (SSI) in neurosurgery. This study sought to analyze whether early debridement improved survival compared to antibiotic therapy alone in patients with postcraniotomy infections after oncological neurosurgeries.

Methods:

We retrospectively reviewed patient records from 2011 to 2019 to identify patients that had been reoperated for the debridement of SSI after brain tumor resection. If SSI was suspected but not clinically evident, the diagnosis was confirmed by cerebrospinal fluid (CSF) analysis or contrast-based imaging examinations. Immediately after diagnosis, broad-spectrum antibiotics were started for all patients.

Results:

Out of 81 SSI cases, 57 underwent debridement. Two patients were reoperated 3 times, and three had two surgeries, resulting in a total of 64 procedures. The number of days between SSI diagnosis and surgical intervention did not influence mortality in both univariate and multivariable analyses (Hazard ratio [HR] 1.03, 95% CI 0.93–1.13). Early debridement (<24 h) did not influence rates of antibiotic prescription at discharge (P = 0.53) or hospital length of stay (LOS) (P = 0.16). Higher neutrophil-lymphocyte ratios (NLRs) were associated with the lower survival (HR 1.05, 95% Confidence interval [CI] 1.01–1.08). Multiple cutoffs were tested and values above 3.5 are more significantly associated with worse outcomes (HR 2.2; 95%CI 1.1–4.2).

Conclusion:

Early debridement does not seem to influence the survival, rates of antibiotic at discharge, or hospital LOS of patients presenting with SSI after neurosurgery for intracranial tumors. High NLRs are strong predictors of worse prognosis in this population.

Oral candidiasis in patients with hematological diseases: Diagnosis through clinical and cytopathological examinations

OBJECTIVE

This study is the first to analyze the prevalence of oral candidiasis in onco-hematological patients by physical and oral cytopathological examinations.

METHODS

This is a cross-sectional and observational study with a retrospective sample composed of participants hospitalized in the hematology clinic, diagnosed with hematological diseases. All participants were submitted to an oral mucosal examination and scraping from oral mucosa.

RESULTS

Of the 62 participants, 56.5% were male, 82.3% were white, with mean age of 57 years. Lymphoma was the most common hematological disease (24.2%). In total, 48.4% of the sample was diagnosed with oral candidiasis. Of these participants with oral candidiasis, 13 (21.0%) had clinical diagnosis. Cytopathological analysis revealed more 17 (27.4%) cases, without oral lesion indicative of candidiasis. Erythematous candidiasis (p=0.02), pseudomembranous candidiasis (p<0,001), clinical candidiasis (p<0,001), fibrous hyperplasia (p=0,032), and coated tongue (p=0,012) showed correlation to candidiasis cytopathologic diagnosis.

CONCLUSIONS

Oral candidiasis is common among patients with hematological disease, and the cytopathological examination proved to be a useful tool, confirming clinical diagnosis of candidiasis and identifying subclinical cases. These data are of great relevance considering the possible complications that these patients may develop such as longer hospitalizations, worsening of the general condition or even death due to candidemia.

Time trends in primary therapy and relative survival of diffuse large B-cell lymphoma by stage: a nationwide, population-based study in the Netherlands, 1989-2018

It is unclear whether survival in diffuse large B-cell lymphoma (DLBCL) continues to increase in an era where rituximab-containing chemotherapy reigns for almost two decades. Therefore, we evaluated trends in primary therapy and relative survival (RS) among Dutch DLBCL patients diagnosed between 1989 and 2018. Analyses were performed separately according to the stage I (N = 6952) and stage II–IV disease (N = 20,676), stratified by calendar period and age (18–64, 65–74, and ≥75 years). The use of chemotherapy ± radiotherapy increased over time across all age and stage groups. As of the mid-2000s, >95% of chemotherapy-treated patients received chemoimmunotherapy, irrespective of age and stage. Overall, RS increased significantly over time across all age groups, especially after 2003 when rituximab-containing chemotherapy had become the standard of care. However, RS increased less pronounced between 2003–2010 and 2011–2018 than between 1989–2002 and 2003–2010. These findings were congruent across all studied stage groups. Five-year RS across the three age groups during 2011–2018 was 96%, 84%, and 67% for stage I DLBCL and 75%, 60%, and 46% for stage II–IV DLBCL. Collectively, survival in DLBCL increased modestly beyond the initial introduction of rituximab, with apparent survival differences across age and stage that warrant novel treatment approaches.

Incidence and spectrum of infections among HIV/AIDS patients with lymphoma during chemotherapy

Introduction Lymphoma is the most common cancer in HIV/AIDS patients. Chemotherapy regiments recommended for lymphomas in HIV-negative patients are also used for lymphomas in HIV/AIDS patients. Little is known about the infections among HIV/AIDS patients with lymphoma undergoing chemotherapy. Methods This retrospective study investigated the incidence, spectrum of and risk factors for infections during chemotherapy in 164 HIV/AIDS patients with lymphoma admitted to Shanghai Public Health Clinical Center from July 2013 to December 2020. Results The median age of the patients was 43 years old; 90.9% (149/164) were male. A total of 112 (68.3%) patients had a CD4 count < 200 cells/μL at lymphoma diagnosis. Diffuse large B-cell lymphoma (56%, 91/164) and Burkitt lymphoma (28%, 46/164) were the two most common subtypes of lymphoma. Among the 137 patients who underwent chemotherapy (total cycles = 749), 58.4% (80/137) of patients experienced a total of 153 episodes of infection, with an incidence rate of 20.4% (153/749). The most commonly seen infections were lung infection (29.2%, 40/137) and febrile neutropenia (27.0%, 37/137). Multivariate analysis showed that grade 4 neutropenia during chemotherapy (OR = 7.128, 95% CI 3.051-16.654, p < 0.001) and duration of antiretroviral treatment at lymphoma diagnosis <6 months (OR = 3.520, 95% CI 1.432-8.653, p = 0.006) were independent risk factors for infection during chemotherapy. Conclusions A large proportion of HIV/AIDS patients with lymphoma may be at risk of infection during chemotherapy. Effective measures should be taken for patients with high risk factors to prevent the occurrence of infection.