Contributions
Abstract: PB1587
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Cell-mediated immunodeficiency-related infectious diseases occasionally occur in the hematologic department of our hospital, although with much lower incidence than neutropenia-related infections other than stem cell transplantation (SCT).
Aims
In this study, we explored which hematologic diseases (HD) and treatments are most likely to be associated with certain infectious diseases in our hospital.
Methods
We retrospectively extracted data on patients who were infected with specific cell-mediated immunodeficiency-related pathogens prior to December 31 2020 in the hematologic department. Target patients had been diagnosed between January 1 2010 and December 31 2019 with representative HD, which included leukemia, lymphoma, myeloma, myelodysplastic syndrome, myeloproliferative neoplasm, warm autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura, and aplastic anemia. Patients who had more than one HD were categorized according to the predominant disease during infection. The pathogens of focus were Cytomegalovirus (CMV), Cryptococcus (Crypto), Listeria (Lis), Nocardia (Nocar), Mycobacterium tuberculosis (TB), Mycobacterium other than TB (AM), and Pneumocystis jirovecii (PC). These pathogens were selected based on the outbreak situation in our area, diagnostic facilities in the hospital, and pathogens that rarely occur in other immunodeficiency status like neutropenia or humoral immune defect. Infectious pathogens were defined by cell culture, pathology, or PCR and needed treatment. We excluded patients who were: (1) infected and treated before diagnosis of HD; (2) infected after SCT; (3) diagnosed in another hospital and admitted for treatment of the infectious disease; (4) only diagnosed by immunological or serological tests; (5) diagnosed with a rare HD, seen in fewer than one patient per year. Patient characteristics, type of infectious disease, underlying diseases, and treatment outcomes were analyzed.
Results
Of the 1,904 patients who were diagnosed with the HD during the specified period, 22 patients (1.2%) were infected with pathogens CMV (n = 3), Crypto (4), Lis (4), Nocar (1), TB (3), AM (3), and PC (4). Median age of the patients was 71 years (49–94 years). Primary sites of infection were identified as pulmonary for TB, PC, AM, and Nocar (n = 11), meningitis for Crypto and Lys (5), colitis for CMV (3), and sepsis for Lys (3). Types of treatment for HD undertaken at the time of infection were chemotherapy (n = 9) (cyclophosphamide plus steroid [2], R-CHOP [1], daratuzumab [1], anthracycline plus cytarabine [1], dasatinib plus steroid [1], and others [3]), steroid (7), and no treatment or completed (4). Two patients were diagnosed with infections at the time of HD diagnosis. Seventeen patients recovered from the infections, while five patients died during treatment. All deceased patients had poor control of their HD. HD associated with multiple infectious diseases were: AIHA (n = 5/21, 23.8%; Crypto [2], CMV [1], TB [1], AT [1]); angioimmunoblastic T-cell lymphoma (n = 3/29, 10.3%; Crypto [1], CMV [1], PC [1]); multiple myeloma (n = 3/186, 1.6%; PC [2], Lis [1]); acute lymphoblastic leukemia (n = 2/53, 3.8%; PC [1], TB [1]); and diffuse large B cell lymphoma (n = 2/465, 0.4%; TB [1], AM [1]).
Conclusion
Over 20% of AIHA patients were infected with cell-mediated immunodeficiency-related infectious diseases. Long-term steroid administration may have been the main contributing factor, although underlying diseases that cause immunodeficiency should also be considered.
Keyword(s): Autoimmune hemolytic anemia (AIHA), Immunodeficiency
Abstract: PB1587
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Cell-mediated immunodeficiency-related infectious diseases occasionally occur in the hematologic department of our hospital, although with much lower incidence than neutropenia-related infections other than stem cell transplantation (SCT).
Aims
In this study, we explored which hematologic diseases (HD) and treatments are most likely to be associated with certain infectious diseases in our hospital.
Methods
We retrospectively extracted data on patients who were infected with specific cell-mediated immunodeficiency-related pathogens prior to December 31 2020 in the hematologic department. Target patients had been diagnosed between January 1 2010 and December 31 2019 with representative HD, which included leukemia, lymphoma, myeloma, myelodysplastic syndrome, myeloproliferative neoplasm, warm autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura, and aplastic anemia. Patients who had more than one HD were categorized according to the predominant disease during infection. The pathogens of focus were Cytomegalovirus (CMV), Cryptococcus (Crypto), Listeria (Lis), Nocardia (Nocar), Mycobacterium tuberculosis (TB), Mycobacterium other than TB (AM), and Pneumocystis jirovecii (PC). These pathogens were selected based on the outbreak situation in our area, diagnostic facilities in the hospital, and pathogens that rarely occur in other immunodeficiency status like neutropenia or humoral immune defect. Infectious pathogens were defined by cell culture, pathology, or PCR and needed treatment. We excluded patients who were: (1) infected and treated before diagnosis of HD; (2) infected after SCT; (3) diagnosed in another hospital and admitted for treatment of the infectious disease; (4) only diagnosed by immunological or serological tests; (5) diagnosed with a rare HD, seen in fewer than one patient per year. Patient characteristics, type of infectious disease, underlying diseases, and treatment outcomes were analyzed.
Results
Of the 1,904 patients who were diagnosed with the HD during the specified period, 22 patients (1.2%) were infected with pathogens CMV (n = 3), Crypto (4), Lis (4), Nocar (1), TB (3), AM (3), and PC (4). Median age of the patients was 71 years (49–94 years). Primary sites of infection were identified as pulmonary for TB, PC, AM, and Nocar (n = 11), meningitis for Crypto and Lys (5), colitis for CMV (3), and sepsis for Lys (3). Types of treatment for HD undertaken at the time of infection were chemotherapy (n = 9) (cyclophosphamide plus steroid [2], R-CHOP [1], daratuzumab [1], anthracycline plus cytarabine [1], dasatinib plus steroid [1], and others [3]), steroid (7), and no treatment or completed (4). Two patients were diagnosed with infections at the time of HD diagnosis. Seventeen patients recovered from the infections, while five patients died during treatment. All deceased patients had poor control of their HD. HD associated with multiple infectious diseases were: AIHA (n = 5/21, 23.8%; Crypto [2], CMV [1], TB [1], AT [1]); angioimmunoblastic T-cell lymphoma (n = 3/29, 10.3%; Crypto [1], CMV [1], PC [1]); multiple myeloma (n = 3/186, 1.6%; PC [2], Lis [1]); acute lymphoblastic leukemia (n = 2/53, 3.8%; PC [1], TB [1]); and diffuse large B cell lymphoma (n = 2/465, 0.4%; TB [1], AM [1]).
Conclusion
Over 20% of AIHA patients were infected with cell-mediated immunodeficiency-related infectious diseases. Long-term steroid administration may have been the main contributing factor, although underlying diseases that cause immunodeficiency should also be considered.
Keyword(s): Autoimmune hemolytic anemia (AIHA), Immunodeficiency