A nationwide study on inpatient opportunistic infections in patients with chronic lymphocytic leukemia in the pre-ibrutinib era

Vilhjálmur Steingrímsson*, Gauti Kjartan Gíslason, Sigrún Þorsteinsdóttir, Sæmundur Rögnvaldsson, Magnús Gottfreðsson, Thor Aspelund, Ingemar Turesson, Magnus Björkholm, Ola Landgren, Sigurdur Y. Kristinsson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Opportunistic infections in chronic lymphocytic leukemia (CLL) have been described in clinical trials, single-center studies, and case reports. We performed a nationwide study to estimate the incidence and impact of inpatient opportunistic infections. Methods: The incidence rate (IR) and incidence rate ratio (IRR) for Swedish CLL patients diagnosed 1994-2013, and matched controls were calculated, as well as the case-fatality ratio (CFR). Results: Among 8989 CLL patients, a total of 829 opportunistic infections were registered (IR 16.6 per 1000 person-years) compared with 252 opportunistic infections in 34 283 matched controls (IR 0.99). The highest incidence in the CLL cohort was for Pneumocystis pneumonia (200 infections, IR 4.03); Herpes zoster (146 infections, IR 2.94), and Pseudomonas (83 infections, IR 1.66) infections. The highest risk relative to matched controls was observed for Pneumocystis pneumonia (IRR 114, 95% confidence interval 58.7-252). The 60-day CFR for CLL patients with opportunistic infections was 23% (188/821), highest for progressive multifocal encephalopathy (5/7, 71%) and aspergillosis (25/60, 42%). Conclusion: We have uniquely depicted the incidence of rare and serious infections in CLL patients and found a relatively high incidence of Pneumocystis pneumonia. Of the most common opportunistic infections, CLL patients with aspergillosis had the poorest prognosis.

Original languageEnglish
Pages (from-to)346-353
Number of pages8
JournalEuropean Journal of Haematology
Volume106
Issue number3
DOIs
Publication statusPublished - 3 Dec 2020

Bibliographical note

Funding Information:
OL: Funding support provided by the Memorial Sloan Kettering Core Grant (P30 CA008748) and OL has received research funding from: National Institutes of Health (NIH), US Food and Drug Administration (FDA), Multiple Myeloma Research Foundation (MMRF), International Myeloma Foundation (IMF), Leukemia and Lymphoma Society (LLS), Perelman Family Foundation, Rising Tides Foundation, Amgen, Celgene, Janssen, Takeda, Glenmark, Seattle Genetics, Karyopharm; Honoraria/ad boards: Adaptive, Amgen, Binding Site, BMS, Celgene, Cellectis, Glenmark, Janssen, Juno, Pfizer; and serves on Independent Data Monitoring Committees (IDMCs) for clinical trials lead by Takeda, Merck, Janssen, Theradex.

Funding Information:
This research was supported by grants from the Swedish Blodcancerfonden, the Swedish Cancer Society, the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, the Karolinska Institutet Foundations, the University of Iceland Research Fund, Icelandic Centre for Research (RANNIS), and Landspitali University Hospital Research Fund.

Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Other keywords

  • Adenine/administration & dosage
  • Aged
  • Cross Infection/epidemiology
  • Humans
  • Incidence
  • Inpatients
  • Leukemia, Lymphocytic, Chronic, B-Cell/complications
  • Male
  • Opportunistic Infections/epidemiology
  • Piperidines/administration & dosage
  • Prognosis
  • Public Health Surveillance
  • Registries
  • Risk Factors
  • Sweden/epidemiology

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