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Reynolds G, Anderson MA, Thursky K, Teh BW, Slavin MA. Recommendations on prevention of infections in patients with T-cell lymphomas: a narrative review and synthesis. Leuk Lymphoma 2023; 64:2057-2070. [PMID: 37688482 DOI: 10.1080/10428194.2023.2252945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
T/Natural killer (NK) cell lymphomas (TCL) represent a heterogenous subgroup of non-Hodgkin lymphoma, associated with poorer prognosis and higher treatment toxicity. A cohesive synthesis of infection outcomes among TCL patients is lacking. International guidelines offer no specific recommendations regarding prophylaxis or supportive infection care for TCL patients. This systematic narrative review highlights infection outcomes in TCL patients treated with conventional, and novel therapies. Recommendations for infection screening, antimicrobial prophylaxis and vaccination strategies are outined.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Ko T, Seah C, Gilbertson M, McQuilten Z, Opat S, Dendle C. A Description of the Type, Frequency and Severity of Infections Among Sixteen Patients Treated for T-Cell Lymphoma. J Hematol 2021; 10:123-129. [PMID: 34267849 PMCID: PMC8256920 DOI: 10.14740/jh838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Infections are an important cause of morbidity and mortality in T-cell lymphomas. Factors contributing to increased risk of infection include the nature of the underlying disease, as well as treatment-associated immunosuppression. Currently there are few reports describing the types of infections, including preventable infections, in this cohort of patients. The aim of the study was to identify the type, frequency and severity of infection in patients with T-cell lymphoma undergoing treatment. Methods A case series was performed on all patients with T-cell lymphoma over a 5-year period from 2011 to 2016 at a tertiary Australian hospital. Information was collected from medical record review regarding patient demographics, lymphoma treatment and outcomes, and infectious outcomes. Severe infections were recorded, defined as infection requiring hospitalization. Results Sixteen patients were identified with a diagnosis of T-cell lymphoma who received treatment at our institution. There were 42 discrete episodes of severe infections in total. Severe infections occurred in 81% of patients, with over 40% having more than one infection. The median length of hospital stay was 13 days, 33% required intensive care admission and 14% of infectious episodes resulted in death. Only 50% of infectious episodes were microbiologically proven, with the most common etiology being bacterial. The most commonly isolated organism overall was Staphylococcus aureus, with the most common source of infection being skin and soft tissue. There was one case of cytomegalovirus (CMV) infection and five cases (12%) of invasive fungal infection. The highest rates of infection occurred during progressive disease. Rates of prophylaxis were highest with antiviral agents, and comparatively lower with antibacterial and antifungal agents. Conclusion Infections are frequent, opportunistic and severe in patients with T-cell lymphoma. Our data suggests that fungal prophylaxis may be indicated with T-cell lymphoma.
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Affiliation(s)
- Tina Ko
- Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia
| | - Crystal Seah
- Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia
| | - Michael Gilbertson
- Monash Haematology, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Haematology, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Australia
| | - Zoe McQuilten
- Monash Haematology, Monash Health, Victoria, Australia.,Monash Haematology, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Stephen Opat
- Monash Haematology, Monash Health, Victoria, Australia.,Monash Haematology, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Australia.,Monash University, Victoria, Australia
| | - Claire Dendle
- Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Victoria, Australia
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Wang S, Jayarangaiah A, Malone M, Elrafei T, Steinberg L, Kumar A. Risk of hepatitis B reactivation and cytomegalovirus related infections with Mogamulizumab: A retrospective study of international pharmacovigilance database. EClinicalMedicine 2020; 28:100601. [PMID: 33294815 PMCID: PMC7700953 DOI: 10.1016/j.eclinm.2020.100601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mogamulizumab (Moga) is a C-C chemokine receptor-4 antibody approved in the United States for relapsed /refractory mycosis fungoides and Sézary syndrome. Few cases reported an increased risk of hepatitis B reactivation and cytomegalovirus (CMV) related infection post-Moga. However, literature is limited to mainly case reports and series, while no study has used the Food and Drug Administration adverse events reporting system (FARES) database to investigate the relationship. METHODS Using United States Food and Drug Administration adverse events reporting system database, we collected all cases of hepatitis B reactivation and CMV related infection between January 1, 2011, and December 31, 2019, for Moga and other drugs. The reporting odds ratio (ROR) was calculated, which was considered significant when the lower limit of 95% confidence interval (CI) >1. FINDINGS Three hundred and thirty-eight total adverse cases were reported for Moga during the study period, with 261 cases reported indication for use, including cutaneous T cell lymphoma (47.04%), and adult T cell leukemia/lymphoma (30.18%). Eight cases were reported for hepatitis B reactivation with Moga use, compared to 2290 cases with other medications. The ROR is 143.67 (p<0.001, 95% CI, 71.17-290.04). CMV related infection was noted in 17 cases using Moga, while 12,849 cases with others. The ROR is 55.89 (p<0.001, 95% CI, 34.31-91.06). In the Moga group, five deaths occurred in hepatitis B reactivation patients and nine deaths with CMV cases. INTERPRETATION A signal has been identified between Moga exposure and hepatitis B reactivation as well as CMV related infection. A consideration in future studies should be placed on determining the relationship and investigating the need for pre-treatment screening, close monitoring, and utilization of prophylaxis in this population-based on pre-treatment risks. FUNDING None.
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Affiliation(s)
- Shuai Wang
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, United States
| | - Apoorva Jayarangaiah
- Department of Hematology-Oncology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, United States
| | - Mariuxi Malone
- Department of Hematology-Oncology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, United States
| | - Tarek Elrafei
- Department of Hematology-Oncology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, United States
| | - Lewis Steinberg
- Department of Hematology-Oncology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, United States
| | - Abhishek Kumar
- Department of Hematology-Oncology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, United States
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Jacobson N, Hickman A, Compton L, Jones H. A case of rash and joint pains in an 85-year-old male on immunosuppression. Int J Womens Dermatol 2020. [DOI: 10.1016/j.ijwd.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Biologic drugs have revolutionized the treatment of certain hematologic, autoimmune, and malignant diseases, but they may place patients at risk for reactivation or acquisition of tuberculosis. This risk is highest with the tumor necrosis factor-alpha (TNF-α) inhibitors. Amongst this class of drugs, the monoclonal antibodies (infliximab, adalimumab, golimumab) and antibody fragment (certolizumab) carry an increased risk compared to the soluble receptor fusion molecule, etanercept. Treatment of latent TB is critical to decrease the risk of reactivation. Data continues to emerge regarding tuberculosis risk associated with novel biologics targeting cytokines involved in tuberculosis control.
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Ishii Y, Kawakami H, Mekata T, Sugiyama A. Histopathological Features of Mycobacterium chelonae Infection in Two Farmed Japanese Pufferfish (Takifugu rubripes). J Comp Pathol 2019; 170:86-90. [PMID: 31375164 DOI: 10.1016/j.jcpa.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023]
Abstract
Granulomatous lesions were observed in the swim bladder, kidney, spleen and gills of two farmed Japanese pufferfish (Takifugu rubripes) infected with Mycobacterium chelonae. Three types of lesions were noted: unencapsulated clusters of epithelioid cells without central necrosis (type 1), encapsulated granulomas without central necrosis (type 2) and encapsulated granulomas with central necrosis (type 3). Type 3 lesions occurred most frequently in the swim bladder, while type 1 and type 2 lesions occurred frequently in the kidney and spleen, and the gills exhibited mostly type 1 lesions. This suggests that the lesions in the swim bladder were more fully developed than those occurring elsewhere and that the swim bladder may be more susceptible to infection with M. chelonae. This is the first report describing the histopathological features of M. chelonae infection in Tetraodontidae.
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Affiliation(s)
- Y Ishii
- Ehime Fisheries Research Center, Ehime Research Institute of Agriculture, Forestry and Fisheries, Ehime, Japan
| | - H Kawakami
- Ehime Fisheries Research Center, Ehime Research Institute of Agriculture, Forestry and Fisheries, Ehime, Japan
| | - T Mekata
- National Research Institute of Aquaculture, Japan Fisheries Research and Education Agency, Mie, Japan
| | - A Sugiyama
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan.
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Verghese E, Jabri A, Watkins RR. Successful Treatment of a Renal Abscess Caused by Mycobacterium chelonae: A Case Report. Open Forum Infect Dis 2018; 5:ofy196. [PMID: 30186889 PMCID: PMC6119465 DOI: 10.1093/ofid/ofy196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ahmad Jabri
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, Ohio
- Department of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
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Drgona L, Gudiol C, Lanini S, Salzberger B, Ippolito G, Mikulska M. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Agents targeting lymphoid or myeloid cells surface antigens [II]: CD22, CD30, CD33, CD38, CD40, SLAMF-7 and CCR4). Clin Microbiol Infect 2018; 24 Suppl 2:S83-S94. [DOI: 10.1016/j.cmi.2018.03.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 01/12/2023]
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Harp GM, Achcar RD, Drummond WK. Necrotizing osteomyelitis in a man with disseminated Mycobacterium chelonae infection. IDCases 2018; 12:71-73. [PMID: 29942753 PMCID: PMC6010973 DOI: 10.1016/j.idcr.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Cases of disseminated nontuberculous mycobacterial (NTM) infection are difficult to treat. We encountered an elderly man with disseminated Mycobacterium chelonae infection. The clinical evaluation and treatment of patients with this type of systemic infection pose unique challenges. Disseminated NTM infection with bone involvement often requires surgical intervention in addition to antimicrobial therapy.
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Affiliation(s)
- Garrett M Harp
- Department of Pulmonary Medicine, Naval Medical Center San Diego, San Diego, CA, USA
| | - Rosane Duarte Achcar
- Division of Pathology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Wendi K Drummond
- Division of Mycobacterial and Infectious Diseases, Department of Medicine, National Jewish Health, Denver, CO, USA
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