INFECTIOUS COMPLICATIONS AS A PREDICTOR OF MORTALITY IN PATIENTS WITH NON-HODGKIN LYMPHOMA RECEIVING RITUXIMAB-CONTAINING CHEMOTHERAPY

Rev Invest Clin. 2019;71(4):275-282. doi: 10.24875/RIC.19002982.

Abstract

Background: Rituximab is a monoclonal antibody that increases the disease-free and overall survival of patients with non-Hodgkin lymphoma (NHL) CD20+. The objective of this study is to describe the prevalence and spectrum of infections in patients with NHL receiving rituximab-containing chemotherapy and the impact on survival.

Materials and methods: From January 2011 to December 2012, all patients diagnosed with NHL who received at least one dose of rituximab were included.

Results: During the study period, 265 patients received rituximab; 108 (40.8%) males; the mean age was 60 ± 15 years. There were 177 infections in 85 patients, being the most common febrile neutropenia (n = 38; 21.5%) and mucosal barrier injury-related infections (n = 28; 15.8%). In 88 events (49%), there was a microbiologic diagnosis, being bacterial infection the most frequent (39.6%), but tuberculosis (TB) was developed in 4 cases (1.5%; incidence rate 721/100,000 person-year). During follow-up, 71 patients died (27%); in 35 cases, it was related to infection. There were no differences in follow-up between those who died due to infection versus those who died from another cause (p = 0.188). Multivariate analysis for mortality showed that age >60 years, failure to achieve a complete response, and development of an infectious complication increased the risk of death.

Conclusions: It is important to perform a screening test for TB in all patients who will receive rituximab and maintain a constant monitoring to detect an infectious process and begin treatment as soon as possible.

Keywords: Infection; Non-Hodgkin lymphoma; Rituximab; Tuberculosis.

MeSH terms

  • Age Factors
  • Aged
  • Antineoplastic Agents, Immunological / administration & dosage*
  • Bacterial Infections / epidemiology
  • Disease-Free Survival
  • Febrile Neutropenia / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Infections / epidemiology*
  • Infections / microbiology
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Lymphoma, Non-Hodgkin / mortality
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Rituximab / administration & dosage*
  • Survival Rate
  • Tuberculosis / epidemiology

Substances

  • Antineoplastic Agents, Immunological
  • Rituximab