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Xue M, Gao Z, Yan M, Bao Y. Profiling risk factors for separation of infection complications in patients with gastrointestinal and nodal diffuse large B-cell lymphoma. BMC Infect Dis 2023; 23:711. [PMID: 37864133 PMCID: PMC10589955 DOI: 10.1186/s12879-023-08671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVE To identify risk factors for infection complications in patients with gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) and nodal DLBCL (N-DLBCL) during treatment, respectively. METHODS Total 51 GI-DLBCL patients and 80 N-DLBCL patients were included after retrieving clinical data from a single medical center in the past ten years. Logistic regression analysis was utilized to analyze patients' data, including baseline demographics, treatments and laboratory values, to determine independent risk factors of infection in these patients. RESULTS Total 28 of 51 patients (54.9%) in the GI-DLBCL group and 52 of 80 patients (65%) in the N-DLBCL group were observed infection events during treatment. A multivariate logistic regression model revealed that Ann-arbor stage IV (P = 0.034; odds ratio [OR]: 10.635; 95% confidence interval [CI]: 1.152-142.712), extra-nodal lesions ≥ 2 (P = 0.041; OR: 23.116; 95%CI: 1.144-466.949) and high serum lactate dehydrogenase (LDH) at the time of diagnosis (LDH > 252U/L; P = 0.033; OR: 6.058; 95%CI: 1.159-31.659) were independent risk factors for the development of infection in patients with GI-DLBCL after systemic treatment. In the N-DLBCL group, high serum C-reactive protein (CRP) (P = 0.027; OR: 1.104; 95%CI: 1.011-1.204) and a low platelet count (P = 0.041; OR: 0.991; 95%CI: 0.982-1.000) at routine blood tests just before infection occurred were identified as significant risk factors related to infection events during treatment. CONCLUSIONS Discordant independent risk factors induced infection may be present during the treatment in patients with GI-DLBCL and N-DLBCL. Close monitoring these risk factors is likely an effective strategy to prevent microbial infections in these patients.
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Affiliation(s)
- Min Xue
- Graduate School, Bengbu Medical College, 2600 Donghai Road, Bengbu, 233000, Anhui, China
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China
| | - Zhenzhen Gao
- The Department of Oncology, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China
| | - Miaolong Yan
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China
| | - Yi Bao
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China.
- The Department of Oncology, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China.
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Berger T, Shochat T, Aumann S, Nachmias B, Goldschmidt N, Horesh N, Harel R, Aviv A, Shmerts E, Abadi U, Shimony S, Raanani P, Gafter-Gvili A, Gurion R. Rituximab versus obinutuzumab-based first-line chemoimmunotherapy for follicular lymphoma-a real-world multicenter retrospective cohort study. Ann Hematol 2023:10.1007/s00277-023-05306-2. [PMID: 37335322 DOI: 10.1007/s00277-023-05306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
The GALLIUM study showed a progression-free survival advantage of 7% in favor of obinutuzumab vs. rituximab-based immunochemotherapies as first-line therapy in follicular lymphoma (FL) patients. Yet, the toxicity appears to be increased with obinutuzumab-based therapy. This is a multicenter retrospective-cohort study including adult FL patients comparing the toxicity of first-line rituximab vs. obinutuzumab-based chemo-immunotherapies (R and O groups, respectively). We compared the best standard-of-care therapy used per time period, before and after obinutuzumab approval. The primary outcome was any infection during induction and 6 months post-induction. Secondary outcomes included rates of febrile neutropenia, severe and fatal infections, other adverse events, and all-cause mortality. Outcomes were compared between groups. A total of 156 patients were included in the analysis, 78 patients per group. Most patients received bendamustine (59%) or CHOP (31.4%) as adjacent chemotherapy. Half of the patients received growth-factor prophylaxis. Overall, 69 patients (44.2%) experienced infections, and a total of 106 infectious episodes were recorded. Patients in the R and O groups had similar rates of any infection (44.8% and 43.5%, p = 1), severe infections (43.3% vs. 47.8%, p = 0.844), febrile neutropenia (15% vs. 19.6%, p = 0.606), and treatment discontinuation, as well as similar types of infections. No covariate was associated with infection in multivariable analysis. No statistically significant difference was evident in adverse events of grades 3-5 (76.9% vs. 82%, p = 0.427). To conclude, in this largest real-life study of first-line treated FL patients comparing R- to O-based therapy, we did not observe any difference in toxicity during the induction and 6 months post-induction period.
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Affiliation(s)
- Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Laboratory of Genome Maintenance, The Rockefeller University, New York, NY, USA.
| | - Tzippy Shochat
- Rabin Medical Center, Bio-Statistical Unit, Beilinson Campus, Petah-Tikva, Israel
| | - Shlomzion Aumann
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Boaz Nachmias
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nurit Horesh
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Reut Harel
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Ariel Aviv
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Ella Shmerts
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Abadi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel
| | - Shai Shimony
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine A, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alelyani RH, Alghamdi AH, Almughamisi TA, Alshareef AM, Kadasa AN, Alrajhi AM, Alburayk AK, Barefah AS, Radhwi OO, Almohammadi AT, Bahashawan SM, AlAhwal HM. Incidence and Risk Factors of Infections Among Diffuse Large B-cell Lymphoma and Classical Hodgkin's Lymphoma Patients in a Tertiary Care Center in Saudi Arabia: A Retrospective Cohort Study. Cureus 2023; 15:e35922. [PMID: 36911585 PMCID: PMC9996399 DOI: 10.7759/cureus.35922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION Non-Hodgkin's lymphoma (NHL) ranked fourth among all cancer types in Saudi Arabia, as reported by the Saudi Health Council in 2015. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type of NHL. On the other hand, classical Hodgkin's lymphoma (cHL) ranked sixth and had a modest tendency to affect young men more frequently. Over recent decades, DLBCL patients were treated with cyclophosphamide, doxorubicin hydrochloride, oncovin, and prednisolone (CHOP) alone. Adding rituximab (R) to the standard regimen (CHOP) shows significant improvement in overall survival. However, it also has a considerable effect on the immune system, impacting complement-mediated and antibody-dependent cellular cytotoxicity and causing an immunosuppressive state through modulating T-cell immunity via neutropenia, which can let the infection spread. AIMS AND OBJECTIVES This study aims to evaluate the incidence and risk factors associated with infections in DLBCL patients in comparison to patients with cHL treated with doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate, and dacarbazine (ABVD). MATERIALS AND METHODS This study is a retrospective case-control study that included 201 patients acquired between January 1st, 2010, and January 1st, 2020. Sixty-seven patients had a diagnosis of cHL and had received ABVD, and 134 had DLBCL and had received rituximab. Clinical data were obtained from the medical records. RESULTS During the study period, we enrolled 201 patients, of whom 67 had cHL, and 134 had DLBCL. DLBCL patients had a higher serum lactate dehydrogenase upon diagnosis than cHL (p = 0.005). Both groups have similar response rates with complete remission/partial remission. Compared to cHL, patients with DLBCL were more likely to have advanced disease when they first presented (stage III/IV, DLBCL: 67.3 vs. cHL: 56.5; p = 0.005). DLBCL patients had an increased risk of infection as compared to cHL patients (DLBCL: 32.1 % vs. 16.4%; p = 0.02). However, patients with a poor response to treatment had an increased risk of infection compared to patients with a favorable response regardless of the type of disease (odds ratio: 4.6; p = <0.001). When using multivariate analysis, it is revealed that unfavorable therapeutic response continues to be the only predictor raising the probability of infection in the population (odds ratio: 4.2; p = 0.003). CONCLUSIONS Our study explored all potential risk factors for the occurrence of infection in DLBCL patients who received R-CHOP versus cHL. The most reliable predictor of an increased risk of infection during the follow-up period was having an unfavorable response to medication. To assess these results, additional prospective research is required.
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Affiliation(s)
- Rakan H Alelyani
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ali H Alghamdi
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | | | - Abdulaziz N Kadasa
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Amir M Alrajhi
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdullah K Alburayk
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ahmed S Barefah
- Hematology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.,Hematology, King Fahd Medical Research Center, Jeddah, SAU
| | - Osman O Radhwi
- Hematology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.,Hematology, King Fahd Medical Research Center, Jeddah, SAU
| | - Abdullah T Almohammadi
- Hematology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.,Hematology, King Fahd Medical Research Center, Jeddah, SAU
| | - Salem M Bahashawan
- Hematology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.,Hematology, King Fahd Medical Research Center, Jeddah, SAU
| | - Hatem M AlAhwal
- Hematology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.,Hematology, King Fahd Medical Research Center, Jeddah, SAU
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Farina N, Ramirez GA, De Lorenzo R, Di Filippo L, Conte C, Ciceri F, Manfredi AA, Rovere-Querini P. COVID-19: Pharmacology and kinetics of viral clearance. Pharmacol Res 2020; 161:105114. [PMID: 32758635 PMCID: PMC7834389 DOI: 10.1016/j.phrs.2020.105114] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is a pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical spectrum of COVID-19 is broad and varies from mild to severe forms complicated by acute respiratory distress and death. This heterogeneity might reflect the ability of the host immune system to interact with SARS-CoV2 or the characteristics of the virus itself in terms of loads or persistence. Information on this issue might derive from interventional studies. However, results from high-quality trials are scarce. Here we evaluate the level of evidence of available published interventional studies, with a focus on randomised controlled trials and the efficacy of therapies on clinical outcomes. Moreover, we present data on a large cohort of well-characterized patients hospitalized at a single University Hospital in Milano (Italy), correlating viral clearance with clinical and biochemical features of patients.
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Affiliation(s)
- Nicola Farina
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy
| | - Giuseppe A Ramirez
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy
| | - Rebecca De Lorenzo
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy
| | - Luigi Di Filippo
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy
| | - Caterina Conte
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy; Division of Immunology, Transplantation and Infectious Diseases, via Olgettina 60, 20132 Milano, Italy
| | - Fabio Ciceri
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy; Division of Immunology, Transplantation and Infectious Diseases, via Olgettina 60, 20132 Milano, Italy
| | - Angelo A Manfredi
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy; Division of Immunology, Transplantation and Infectious Diseases, via Olgettina 60, 20132 Milano, Italy
| | - Patrizia Rovere-Querini
- Vita - Salute San Raffaele University, via Olgettina 60, 20132 Milano, Italy; Division of Immunology, Transplantation and Infectious Diseases, via Olgettina 60, 20132 Milano, Italy.
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