Patients With Mantle Cell Lymphoma Face High Risk of Infections Following Diagnosis

Patients with mantle cell lymphoma (MCL) face a heightened incidence of infections prior to and several years after a diagnosis of MCL and associated treatment, emphasizing the importance of thorough assessments of morbidity related to infectious diseases in these patients, according to the results of a study published in HemaSphere.¹

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There has been a growing population of MCL survivors due to the introduction of new treatments. Individuals who have gone through treatment for MCL can face long-term side effects and potential disease relapse, which can compound upon an already weak immune system.¹

“Patients live with an increased risk of infections for many years, which limits their quality of life and can also be very serious,” Antoine Kossi D. Abalo, PhD, MPH, a precision medicine researcher at Uppsala University, said in a news release.²

Patients with MCL may be at a higher risk for infections than other lymphoma subgroups as well. These patients exhibit immune deficiencies involving various immune system components. In addition, the advanced age of MCL patients--they have a median age at diagnosis of over 70 years--and associated age-related physiological decline can lead to higher infection risks.¹

As the field of infections in patients with MCL remains largely unexplored, the investigators looked to investigate the incidence of infections and the causes of death from infections in survivors of MCL compared to the general population in Sweden.¹ The study investigators identified individuals aged 18 years and older who were diagnosed with MCL between 2007 and 2019. For each of these patients, 7-to-10 comparators from the Total Population Register were selected and were paired based on year of birth, year of diagnosis, and sex.¹

There were over 1559 patients and 15,571 comparators followed for a median of 2.9 and 5 years, respectively. Among the patients, 85.2% (n = 1329) developed infections over the follow-up period, of which 1080 patients (69.3%) had at least 1 infection during the first year, the investigators wrote.¹

Infection rate (IR) in patients was 1.05 (1.03-1.08) per person and year vs 0.38 (0.38-0.38) in comparators, while the overall infection rate among patients was 2-fold higher than for comparators. This increased rate was seen across all patient characteristics, including age, sex, and family history of lymphoma.¹

Notably, there was a significant increase in IR during the 4 years before the diagnosis of MCL. Additionally, infections were 4 times more frequent in patients than comparators in the first year following MCL diagnosis, which persisted for 8 years after diagnosis.¹

The most frequent infections observed were influenza and pneumonia, other bacterial infections, other urinary infections, and acute upper respiratory infections. Pneumonia and influenza dominated in absolute numbers with 407 events in patients and had a clearly elevated rate ratio of 3.84 (3.26-4.51).¹

“This shows that, alongside the treatment of lymphoma, we should have strategies to manage and reduce the risk of infections, as well as take measures to limit exposure to bacteria that could lead to infections. That way, we can improve the overall quality of life for patients,” said Ingrid Glimelius,MD, PhD, a senior physician and professor of oncology at Uppsala University Hospital and Uppsala University, in a press release.²

MCL remained the primary leading cause of death among patients, which surprised the study investigators. MCL deaths accounted for 467 out of 817 patient deaths (57%), while infections only led to 21 deaths (2.6%). Among patients who died primarily from MCL, 25.5% (n = 119) had a concomitant infection reported as a secondary cause of death.¹

However, the study authors noted that the infection rate ratios in this study may be slightly overestimated due to surveillance bias, especially during the initial years following diagnosis. They further explained that the results should be interpreted with this in mind.¹

“By delving into these findings, we can pave the way for more effective interventions, ultimately improving the quality and length of life of people battling mantle cell lymphoma,” Kossi D. Abalo said in the press release.²

References

1. Kossi D Abalo A, Ekberg S, Andersson T M L, et al. Infections in patients with mantle cell lymphoma. HemaSphere. 2024;8(7):e121. doi:10.1002/hem3.121

2. EurekAlert! Lymphoma patients at high risk of infections after diagnosis. News release. Published July 8, 2024. Accessed July 17, 2024. https://www.eurekalert.org/news-releases/1050606