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Title: Prolonged lymphopenia and infection risk is mitigated by antimicrobial prophylaxis in patients with indolent non-Hodgkin Lymphoma (iNHL) treated with bendamustine +/- anti-CD20 antibody: the Australian Lymphoma Alliance experience.
Epworth Authors: Yannakou, Costas
Other Authors: Manos, Kate
Lasica, Masa
Grigg, Andrew
Di Ciaccio, Pietro
Wong, Jonathan
Sekaran, Usha
Wight, Joel
Goh, Zhong
Jina, Hayden
Butler, Llewyn
Hamad, Nada
Gregory, Gareth
Gangatharan, Shane
Cochrane, Tara
Piper, Kristen
Churilov, Leonid
Hawkes, Eliza
Keywords: Prolonged Lymphopenia
Infection Risk
Antimicrobial Prophylaxis
Indolent Non-Hodgkin Lymphoma (iNHL)
Anti-CD20 Antibody
Antimicrobial Prophylaxis (ppx)
Multicentre Analysis
Retrospective Analysis
Concomitant Risk Factors
End of Bendamustine Treatment (EOT)
Negative Binomial Regression
Opportunistic Infections (OI)
Post Treatment Cessation
Concomitant Obinutuzumab
Anti-CD20 Maintenance.
Febrile Neutropenia (FN)
Logistic Regression
Epworth Centre for Immunotherapies and Snowdome Laboratories
Molecular Oncology and Cancer Immunology
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Jul-2020
Publisher: American Society of Hematology (ASH)
Citation: Blood (2020) 136 (Supplement 1): 47–49.
Abstract: Bendamustine +/- anti-CD20 antibody is a highly effective regimen for iNHL. Though initially favoured for its toxicity profile, subsequent analyses demonstrate profound and prolonged lymphopenia and the landmark phase III GALLIUM study showed a grade 3-5 infection rate of 20-26% in the bendamustine arms (Hiddemann JCO 2018). The relationship between severity and duration of lymphopenia and infection, and the role of antimicrobial prophylaxis (ppx), are not fully characterised. We performed a multicentre, retrospective analysis of bendamustine-treated iNHL patients (pts) to define the type and onset of infections, identify concomitant risk factors and evaluate the role of ppx. iNHL pts aged ≥18 yrs, treated with bendamustine +/- anti-CD20 in 1st-3rd line from 2011-2019, were identified from 9 Australian centres. HIV, prior transplant and long-term immunosuppression were excluded. Demographics, treatment, lymphocyte counts, infections and ppx were collected from baseline to 24 months post end of bendamustine treatment (EOT) or subsequent lymphoma therapy. Association between potential risk factors and infection was evaluated by logistic regression (odds ratio, OR) and negative binomial regression (incidence rate ratio, IRR) with Stata 16.1. iNHL pts receiving bendamustine are at high risk of prolonged lymphopenia and infectious complications extending beyond treatment completion, with half of infections occurring post treatment cessation. Lymphopenia duration and nadir did not correlate with infection. PJP and antiviral ppx reduced risk of bacterial and VZV/HSV infections respectively, though rates of PJP and VZV/HSV were low. Prolonged ppx to mitigate the risk of late infections should be considered, particularly in pts with additional risk factors such as concomitant obinutuzumab and anti-CD20 maintenance.
DOI: 10.1182/blood-2020-138642
ISSN: 0006-4971
Journal Title: Blood
Type: Journal Article
Affiliated Organisations: Department of Haematology, Austin Health, Melbourne, Australia
St Vincent's Hospital, Melbourne, VIC, AUS
Department of Haematology and Bone Marrow Transplantation, St Vincent's Hospital, Sydney, Australia
Department of Haematology, Monash Health, Clayton, Australia
School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
Fiona Stanley Hospital, Murdoch, Australia
Townsville University Hospital, Douglas, Australia
University of Melbourne, Melbourne, Australia
Gold Coast University Hospital, Southport, Australia
Eastern Health, Box Hill, Australia
St Vincent's Hospital, Fitzroy, Australia
Faculty of Medicine, University of New South Wales, Sydney, Australia
Department of Haematology, St Vincent's Hospital, Sydney, Australia
School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
University of Western Australia, Nedlands, Australia
Fremantle Hospital, Nedlands, WEA, AUS
Department of Hematology, Gold Coast University Hospital, Southport, Australia
St Vincent's Hospital, Sydney, Australia
Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
Austin Health, Heidelberg, VIC, Australia
Department of Medical Oncology and Haematology, Eastern Health, Box Hill, Australia
Type of Clinical Study or Trial: Clinical Trial
Appears in Collections:Cancer Services

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