3.13 Infectious Complications Among Individuals with Monoclonal B-Cell Lymphocytosis (MBL): A Community-based Cohort Study of Newly Diagnosed Patients Compared to Controls
التفاصيل البيبلوغرافية
العنوان:
3.13 Infectious Complications Among Individuals with Monoclonal B-Cell Lymphocytosis (MBL): A Community-based Cohort Study of Newly Diagnosed Patients Compared to Controls
(odds ratio 7.5; p 0.0001) Figure 1A. Even prior to receiving treatment for CLL, the rate of hospitalization for infection remained higher than the control cohort (p 0.002; Figure 1B). The 32 CLL patients hospitalized with infection were admitted with infection a total of 89 times (median 1 hospitalization for infection per patient). A specific infectious organism was identified by cultures or serologies in 60 (63%) of the 89 infections in CLL cases and 10/27 (37%) infections among controls. Hospitalization for an opportunistic infection (e.g. cytomegalovirus, cryptococcus, filamentous fungi, mycobacteria, Pneumocystis) occurred in 5/174 (3%) CLL patients during follow-up compared to 0/689 controls (p 0.001). Finally, we performed a pooled multivariable analysis of all patients (n 863) to identify factors (age, sex, CLL diagnosis, CLL treatment) associated with infection risk. Most factors were independently associated with hospitalization for infection [Age (per year, OR 1.03, p 0.02), sex (male, OR 4.0, p 0.001), diagnosis of CLL (OR 2.1, p 0.09), and treatment for CLL (OR 5.9, p 0.001)]. In univariate analysis of CLL patients [sex (OR 4.2, p 0.01), higher Rai stage (p 0.046), unfavorable (del 17p13; del 11q23) FISH [OR 4.6, p 0.02] and unmutated IGHV [OR 2.8, p 0.07]) were associated with risk of infection. Conclusions: In this cohort study, patients with newly diagnosed CLL had a 7.5-fold risk of hospitalization for infection relative to the control cohort. After a 4 year follow-up, 1 in 5 CLL patients required hospitalization for infection. Although CLL treatment was a substantial risk factor for infection, the risk of infection among untreated patients remained higher than controls.