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

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 in...

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Published in:European journal of haematology 2021-03, Vol.106 (3), p.346-353
Main Authors: Steingrímsson, Vilhjálmur, Gíslason, Gauti Kjartan, Þorsteinsdóttir, Sigrún, Rögnvaldsson, Sæmundur, Gottfreðsson, Magnús, Aspelund, Thor, Turesson, Ingemar, Björkholm, Magnus, Landgren, Ola, Kristinsson, Sigurdur Y.
Format: Article
Language:English
Subjects:
Aspergillosis
Case reports
Chronic lymphocytic leukemia
Clinical trials
Encephalopathy
Herpes zoster
immunology and infectious diseases
Infections
Leukemia
Lymphatic leukemia
lymphoproliferative diseases
Medicin och hälsovetenskap
Pneumonia
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Summary: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.
ISSN:0902-4441
1600-0609
1600-0609
DOI:10.1111/ejh.13553