Increased incidence of infection in patients with myelofibrosis and transfusion-associated iron overload in the clinical setting
Increased incidence of infection in patients with myelofibrosis and transfusion-associated iron overload in the clinical setting
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DOI：
10.1007/s12185-020-02861-6
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发表时间：
2020-03-23
影响因子：
2.1
通讯作者：
La Nasa, Giorgio
中科院分区：
文献类型：
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作者：
Caocci, Giovanni;Simula, Maria Pina;La Nasa, Giorgio
输血相关的铁超负荷可能导致感染的风险增加，但其在骨髓纤维化（MF）中的作用几乎没有探讨。我们评估了106例原发性或继发性MF的连续患者。高达38%的患者为输血依赖型（TD），接受的RBC单位中位数为14个。中位观察时间为36个月（范围3-203）。45%的患者经历了一次或多次感染发作，共发生69起感染事件，其中13起（19%）为重度感染。60个月累积感染发生率为64.1 +/-6.5%。TD患者的感染发生率较高（HR = 2.13，p = 0.019）。TD合并感染性并发症患者的输血负担明显更大（中位数24 RBC单位vs 15 RBC单位; p = 0.012）。60个月总生存率为40 +/-5.9%。较低的国际预后评分系统（IPSS）风险（p < 0.0001）和鲁索替尼（p = 0.027）与较高的生存率显著相关。这项真实世界的研究显示，输血负担较高的患者感染增加。因此，进一步研究铁螯合在改善MF患者无感染生存率中的作用可能是有趣的。
Transfusion-associated iron overload may lead to increased risk of infection, but its role in myelofibrosis (MF) has been scarcely explored. We evaluated 106 consecutive patients with primary or secondary MF. Up to 38% of patients were transfusion-dependent (TD) with a median of 14 RBC units received. Median observation time was 36 months (range 3-203). Forty-five percent of patients experienced one or more infectious episodes for a total of 69 infectious events, 13 (19%) of which were severe. The 60-month cumulative incidence of infection was 64.1 +/- 6.5%. TD patients showed a higher incidence of infection (HR = 2.13, p = 0.019). Transfusion burden was markedly greater in TD patients with infectious complication (median 24 RBC units vs 15 RBC units; p = 0.012). The 60-month overall survival was 40 +/- 5.9%. Lower International Prognostic Scoring System (IPSS) risk (p < 0.0001) and ruxolitinib (p = 0.027) were significantly correlated with higher survival. This real-world study showed increased infections in patients with higher transfusion burden. It may therefore be interesting to further investigate the role of iron chelation in improving infection-free survival in MF patients.