Pneumocystis jirovecii pneumonia and institutional prophylaxis practices in CLL patients treated with BTK inhibitors
Pneumocystis jirovecii pneumonia and institutional prophylaxis practices in CLL patients treated with BTK inhibitors
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DOI：
10.1182/bloodadvances.2020001678
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发表时间：
2020-04-14
期刊：
影响因子：
7.5
通讯作者：
Davids, Matthew S.
中科院分区：
文献类型：
--
作者：
Ryan, Christine E.;Cheng, Matthew P.;Davids, Matthew S.
在接受伊鲁替尼治疗的慢性淋巴细胞白血病（CLL）患者中报告了肺孢子虫感染（OI），如肺孢子虫肺炎（PIP），并且是发病率和死亡率的重要原因。目前，关于在接受布鲁顿酪氨酸激酶抑制剂（BTKi）治疗的CLL患者中使用抗生素预防OI，特别是PJP，尚无国际共识指南。我们评估了在我们机构接受BTKi治疗的CLL患者中PJP的频率，并评估了预防对降低PJP风险的影响。我们确定了217例接受BTKi治疗的患者，包括3个队列：143例接受BTKi单药治疗的患者，17 41%接受BTKi单药治疗的患者接受了预防治疗，这是由治疗医生决定的。所有未接受预防治疗的患者中PIP的患病率为3.4%（87例中的3例），特别是在未接受预防治疗的BTKi单药治疗患者中，PIP的患病率为2.4%（85例中的2例）。PIP预防是有效的，因为在接受预防的患者中没有PJP病例（0/130）。我们的研究人群中PJP的患病率相对较低，这表明接受BTKi治疗的CLL患者可能不需要常规预防。
Opportunistic infections (OIs), such as Pneumocystis jirovecii pneumonia (PIP), have been reported in chronic lymphocytic leukemia (CLL) patients treated with ibrutinib, and are an important cause of morbidity and mortality. Currently, there are no international consensus guidelines regarding the use of antimicrobial prophylaxis for OIs, and in particular PJP, in CLL patients treated with Bruton tyrosine kinase inhibitors (BTKi's). We evaluated the frequency of PJP in CLL patients at our institution who were treated with BTKi's, and assessed the impact of prophylaxis on reducing the risk of PJP. We identified 217 patients treated with BTKi's, consisting of 3 cohorts: 143 patients on either BTKi monotherapy with ibrutinib or acalabrutinib, 17 patients receiving ibrutinib combination therapy with umbralisib as part of a clinical trial, and 57 patients receiving ibrutinib in combination with standard chemotherapy, also as part of a clinical trial. Forty-one percent of patients on BTKi monotherapy received prophylaxis, which was given at the discretion of the treating physician. The prevalence of PIP in all patients not on prophylaxis was 3.4% (3 of 87), and, specifically in BTKi-monotherapy patients not on prophylaxis, the PIP prevalence was 2.4% (2 of 85). PIP prophylaxis was effective, as there were no cases of PJP in patients on prophylaxis (0 of 130). The relatively low prevalence of PJP in our study population suggests that routine prophylaxis may not be indicated in CLL patients on BTKi therapy.