Manos, Kate, Churilov, Leonid, Grigg, Andrew, Di Ciaccio, Pietro, Wong, Jonathan, Chandra Sekaran, Usha, Wight, Joel, Goh, Zhong, Jina, Hayden, Butler, Llewyn, Yannakou, Costas K., Hamad, Nada, Gregory, Gareth P., Gangatharan, Shane, Cochrane, Tara, Hawkes, Eliza A., and Lasica, Masa (2024) Infection risk and antimicrobial prophylaxis in bendamustine‐treated patients with indolent non‐Hodgkin lymphoma: An Australasian Lymphoma Alliance study. British Journal of Haematology, 205 (1). pp. 146-157.

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Abstract

Infection and lymphopenia are established bendamustine-related complications. The relationship between lymphopenia severity and infection risk, and the role of antimicrobial prophylaxis, is not well described. This multicentre retrospective study analysed infection characteristics and antimicrobial prophylaxis in 302 bendamustine-treated indolent non-Hodgkin lymphoma patients. Lymphopenia (<1 × 109/L) was near universal and time to lymphocyte recovery correlated with cumulative bendamustine dose. No association between lymphopenia severity and duration with infection was observed. Infections occurred in 44% of patients (50% bacterial) with 27% hospitalised; 32% of infections occurred ≥3 months post bendamustine completion. Infection was associated with obinutuzumab and/or maintenance anti-CD20 therapy, prior therapy and advanced stage. Twenty-four opportunistic infections occurred in 21 patients: ten varicella zoster virus (VZV), seven herpes simplex virus (HSV), one cytomegalovirus, one progressive multifocal leucoencephalopathy, one nocardiosis, one Pneumocystis jiroveci pneumonia (PJP) and three other fungal infections. VZV/HSV and PJP prophylaxis were prescribed to 42% and 54% respectively. Fewer VZV/HSV infections occurred in patients receiving prophylaxis (HR 0.14, p = 0.061) while PJP prophylaxis was associated with reduced risk of bacterial infection (HR 0.48, p = 0.004). Our study demonstrates a significant infection risk regardless of lymphopenia severity and supports prophylaxis to mitigate the risk of early and delayed infections.

Item ID:	85794
Item Type:	Article (Research - C1)
ISSN:	1365-2141
Copyright Information:	© 2024 British Society for Haematology and John Wiley & Sons Ltd.
Date Deposited:	11 Jun 2025 01:42
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3211 Oncology and carcinogenesis > 321199 Oncology and carcinogenesis not elsewhere classified @ 100%
SEO Codes:	28 EXPANDING KNOWLEDGE > 2801 Expanding knowledge > 280103 Expanding knowledge in the biomedical and clinical sciences @ 100%
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