Poor outcome and high prevalence of invasive fungal infections in patients with adult T-cell leukemia/lymphoma exposed to zidovudine and interferon alfa.
Adolescent
Adult
Aged
Antibiotic Prophylaxis
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Aspergillosis
/ epidemiology
Febrile Neutropenia
/ complications
Female
Fever of Unknown Origin
/ epidemiology
Fungemia
/ epidemiology
Humans
Interferon-alpha
/ administration & dosage
Invasive Fungal Infections
/ epidemiology
Kaplan-Meier Estimate
Leukemia-Lymphoma, Adult T-Cell
/ complications
Male
Middle Aged
Opportunistic Infections
/ epidemiology
Pneumonia, Pneumocystis
/ epidemiology
Prevalence
Prognosis
Retrospective Studies
Strongyloidiasis
/ epidemiology
Treatment Outcome
Young Adult
Zidovudine
/ administration & dosage
HTLV-1
Interferon alfa
Invasive fungal infection
Lymphoma
Outcome
Zidovudine
Journal
Annals of hematology
ISSN: 1432-0584
Titre abrégé: Ann Hematol
Pays: Germany
ID NLM: 9107334
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
19
01
2021
accepted:
17
07
2021
pubmed:
14
8
2021
medline:
26
10
2021
entrez:
13
8
2021
Statut:
ppublish
Résumé
Patients treated for adult T-Cell leukemia/lymphoma (ATL) have a poor prognosis and are prone to infectious complications which are poorly described. As the French reference center for ATL, we retrospectively analyzed 47 consecutive ATL (acute, n = 23; lymphoma, n = 14; chronic, n = 8; smoldering, n = 2) patients between 2006 and 2016 (median age 51 years, 96% Afro-Caribbean origin). The 3-year overall survival (OS) was 15.8%, 11.3%, and 85.7% for acute, lymphoma, and indolent (chronic and smoldering) forms respectively. Among aggressive subtypes, 20 patients received, as frontline therapy, high dose of zidovudine and interferon alfa (AZT-IFN⍺) resulting in an overall response rate (ORR) of 39% (complete response [CR] 33%) and 17 chemotherapy resulting of an ORR of 59% (CR 50%). Ninety-five infections occurred in 38 patients, most of whom had an acute subtype (n = 73/95; 77%). During their follow-up, patients receiving frontline chemotherapy or frontline AZT-IFNα developed infections in 74% (n = 14/19) and 89% (n = 24/27) of the cases respectively. Sixty-four (67%) of infections were microbiologically documented. Among them, invasive fungal infections (IFI, n = 11) included 2 Pneumocystis jirovecii pneumonia, 5 invasive aspergillosis, and 4 yeast fungemia. IFI exclusively occurred in patients with acute subtype mostly exposed to AZT-IFNα (n = 10/11) and experiencing prolonged (> 10 days) grade 4 neutropenia. Patients with aggressive subtype experiencing IFI had a lower OS than those who did not (median OS 5.4 months versus 18.4 months, p = 0.0048). ATL patients have a poor prognosis even in the modern era. Moreover, the high rate of infections impacts their management especially those exposed to AZT-IFNα.
Identifiants
pubmed: 34387741
doi: 10.1007/s00277-021-04622-9
pii: 10.1007/s00277-021-04622-9
doi:
Substances chimiques
Interferon-alpha
0
Zidovudine
4B9XT59T7S
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2813-2824Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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