Risk of a second cancer and infection in patients with indolent B‐cell lymphoma exposed to first‐line bendamustine plus rituximab: A retrospective analysis of an administrative claims database
Risk of a second cancer and infection in patients with indolent B‐cell lymphoma exposed to first‐line bendamustine plus rituximab: A retrospective analysis of an administrative claims database
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接受一线苯达莫司汀加利妥昔单抗治疗的惰性 B 细胞淋巴瘤患者发生第二种癌症和感染的风险：行政索赔数据库的回顾性分析
DOI：
10.1002/hon.3128
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发表时间：
2023
影响因子：
3.3
通讯作者：
Muraki Yuichi
中科院分区：
文献类型：
--
作者：
Dote Satoshi;Inose Ryo;Goto Ryota;Kobayashi Yuka;Muraki Yuichi
苯达莫司汀具有有效的免疫抑制作用，因为它会导致T细胞淋巴细胞减少，这可能导致第二原发性恶性肿瘤（SPM），并增加感染的风险。使用医疗数据视觉管理索赔数据库，我们比较了2009年至2020年期间接受利妥昔单抗化疗的未经治疗的惰性B细胞淋巴瘤（iBCL）患者的SPM累积发病率、6个月内感染和总生存率。排除3b级滤泡性淋巴瘤或既往恶性病史的患者。符合条件的5234例患者被分配到三个队列：利妥昔单抗（N= 780）， RCHOP/RCVP/RTHPCOP（用吡柔比星代替阿霉素）（N= 2298），或苯达莫司汀/利妥昔单抗（N= 2156）。有589例SPMs记录，其中骨髓增生异常综合征最常见（1.7%）。BR组患者SPM的累积发病率显著高于单药利美昔单抗组（p< 0.01）或RCHOP/RCVP/RTHPCOP组（p< 0.0001）： 5年累积发病率函数分别为18.1%、12.5%和12.9%。在Fine‐Gray亚分布风险模型中，BR显示SPM的累积发病率显著高于RCHOP/RCVP/RTHPCOP（亚风险比，1.33；95%置信区间[CI]， 1.10-1.61）。此外，在敏感性分析中，一项使用整个队列的嵌套病例对照研究显示了一致的结果：一线苯达莫司汀、一线后苯达莫司汀和任何一线苯达莫司汀的SPM比值比（95% CI）分别为1.43（1.14-1.78）、1.26（0.96-1.64）和1.33（1.09-1.62）。关于感染，与RCHOP/RCVP/RTHPCOP相比，BR的校正优势比（95% CI）如下：巨细胞病毒感染，13.7 (4.88-38.4)；细菌性肺炎，0.63 (0.50-0.78)；肺囊虫性肺炎，0.24（0.11 ~ 0.53）。在滤泡性、套细胞性、边缘带性或淋巴浆细胞性淋巴瘤患者中，RCHOP/RCVP/RTHPCOP与BR的OS无显著差异。总之，考虑化疗后SPM和感染风险的治疗策略对iBCL患者是必要的。
Bendamustine has a potent immunosuppressive effect because it causes T‐cell lymphopenia, which might lead to a second primary malignancy (SPM) and would increase the risk of infection. Using the Medical Data Vision administrative claims database, we compared the cumulative incidence of SPM, infections within 6 months, and overall survival (OS) among untreated patients with indolent B‐cell lymphomas (iBCL) who received rituximab‐based chemotherapy between 2009 and 2020. Patients with grade 3b follicular lymphoma or a previous history of malignancy were excluded. Eligible 5234 patients were assigned to three cohorts: rituximab monotherapy (N= 780), RCHOP/RCVP/RTHPCOP (doxorubicin replaced with pirarubicin) (N= 2298), or bendamustine/rituximab (BR) (N= 2156). There were 589 recorded SPMs, of which myelodysplastic syndromes were the most common (1.7%). The cumulative incidence of SPM was significantly higher in patients treated with BR than in those treated with rituximab monotherapy (p< 0.01) or RCHOP/RCVP/RTHPCOP (p< 0.0001): the 5‐year cumulative incidence function was 18.1%, 12.5%, and 12.9%, respectively. In the Fine‐Gray subdistribution hazards model, BR showed a significantly higher cumulative incidence of SPM than RCHOP/RCVP/RTHPCOP (subhazard ratio, 1.33; 95% confidence interval [CI], 1.10–1.61). Furthermore, in sensitivity analysis, a nested case‐control study using an entire cohort showed consistent results: the SPM odds ratios (95% CI) of first‐line bendamustine, bendamustine after first‐line, and any‐line bendamustine were 1.43 (1.14–1.78), 1.26 (0.96–1.64), and 1.33 (1.09–1.62), respectively. Regarding infections, adjusted odds ratios (95% CI) of BR compared to RCHOP/RCVP/RTHPCOP were as follows: cytomegalovirus infection, 13.7 (4.88–38.4); bacterial pneumonia, 0.63 (0.50–0.78); and pneumocystis pneumonia, 0.24 (0.11–0.53). There was no significant difference in OS between RCHOP/RCVP/RTHPCOP and BR in patients with follicular, mantle cell, marginal zone, or lymphoplasmacytic lymphomas. In conclusion, treatment strategies that consider the risk of SPM and infections after chemotherapy are warranted in patients with iBCL.
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DOI：
10.37737/ace.22004
发表时间：
2022-01-01
期刊：
Annals of clinical epidemiology
影响因子：
--
作者：
Nishikawa, Atsushi;Yoshinaga, Eiko;Koide, Daisuke
通讯作者：
Koide, Daisuke
影响因子：
45.3
作者：
Hiddemann, Wolfgang;Barbui, Anna Maria;Marcus, Robert E.
通讯作者：
Marcus, Robert E.
影响因子：
3.3
作者：
Hara, Takeshi;Yoshikawa, Takeshi;Tsurumi, Hisashi
通讯作者：
Tsurumi, Hisashi
利妥昔单抗时代滤泡性淋巴瘤患者化疗效果比较研究：日本理赔数据库研究。
影响因子：
3.3
作者：
Saaya Tsutsué;K. Tobinai;J. Yi;B. Crawford
通讯作者：
B. Crawford
影响因子：
12.8
作者：
Olszewski, Adam J.;Butera, James N.;Castillo, Jorge J.
通讯作者：
Castillo, Jorge J.