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Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP

Eyre, Toby A.; Wilson, William; Kirkwood, Amy A.; Wolf, Julia; Hildyard, Catherine; Plaschkes, Hannah; Griffith, John; Fields, Paul; Gunawan, Arief; Oliver, Rebecca; Booth, Stephen; Kothari, Jaimal; Fox, Christopher P.; Martinez-Calle, Nicolas; McMillan, Andrew; Bishton, Mark; Collins, Graham P.; Hatton, Chris S. R.

Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP Thumbnail


Authors

Toby A. Eyre

William Wilson

Amy A. Kirkwood

Julia Wolf

Catherine Hildyard

Hannah Plaschkes

John Griffith

Paul Fields

Arief Gunawan

Rebecca Oliver

Stephen Booth

Jaimal Kothari

CHRIS FOX Christopher.Fox@nottingham.ac.uk
Clinical Professor in Haematology

Nicolas Martinez-Calle

Andrew McMillan

Mark Bishton

Graham P. Collins

Chris S. R. Hatton



Abstract

Infection-related morbidity and mortality are increased in older patients with diffuse large B-cell lymphoma (DLBCL) compared with population-matched controls. Key predictive factors for infection-related hospitalization during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and deaths as a result of infection in older patients during and after treatment with R-CHOP remain incompletely understood. For this study, 690 consecutively treated patients age 70 years or older who received full-dose or attenuated-dose R-CHOP treatment were analyzed for risk of infection-related hospitalization and infection-related death. Median age was 77 years, and 34.4% were 80 years old or older. Median follow-up was 2.8 years (range, 0.4-8.9 years). Patient and baseline disease characteristics were assessed in addition to intended dose intensity (IDI). Of all patients, 72% were not hospitalized with infection. In 331 patients receiving an IDI $80%, 33% were hospitalized with $1 infections compared with 23.3% of 355 patients receiving an IDI of,80% (odds ratio, 1.61; 95% confidence interval, 1.15-2.25; P 5 .006). An increased risk of infection-related admission was independently associated with IDI .80% across the whole cohort. Primary quinolone prophylaxis independently reduced infection-related admission. A total of 51 patients died as a result of infection. The 6-month, 12-month, 2-year, and 5-year cumulative incidences of infection-related death were 3.3%, 5.0%, 7.2%, and 11.1%, respectively. Key independent factors associated with infection-related death were an International Prognostic Index (IPI) score of 3 to 5, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score $6, and low albumin, which enabled us to generate a predictive risk score. We defined a smaller group (15%) of patients (IPI score of 0-2, albumin .36 g/L, CIRS-G score,6) in which no cases of infection-related deaths occurred at 5 years of follow-up. Whether patients at higher risk of infection-related death could be targeted with enhanced antimicrobial prophylaxis remains unknown and will require a randomized trial.

Citation

Eyre, T. A., Wilson, W., Kirkwood, A. A., Wolf, J., Hildyard, C., Plaschkes, H., …Hatton, C. S. R. (2021). Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP. Blood Advances, 5(8), 2229-2236. https://doi.org/10.1182/bloodadvances.2021004286

Journal Article Type Article
Acceptance Date Mar 21, 2021
Online Publication Date Apr 23, 2021
Publication Date Apr 27, 2021
Deposit Date Dec 15, 2022
Publicly Available Date Jan 18, 2023
Journal Blood Advances
Electronic ISSN 2473-9537
Publisher American Society of Hematology
Peer Reviewed Peer Reviewed
Volume 5
Issue 8
Pages 2229-2236
DOI https://doi.org/10.1182/bloodadvances.2021004286
Keywords Hematology
Public URL https://nottingham-repository.worktribe.com/output/14322764
Publisher URL https://ashpublications.org/bloodadvances/article/5/8/2229/475791/Infection-related-morbidity-and-mortality-among

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