Higher Treatment Dose Intensity Increases Infection Risk in Older Patients With DLBCL

Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) at an intended dose intensity of 80% or higher was independently associated with an increased risk of hospitalization for infection in a cohort of older patients with diffuse large B-cell lymphoma (DLBCL), according to findings published in Blood Advances. 

For the study, UK-based researchers followed 690 consecutively treated patients with DLBCL who were 70 years or older and received full- or attenuated-dose R-CHOP. Among the patients, the median age was 77 years, and 34.4% were age 80 or older. 

All in all, 72% of patients had no infection-related hospitalizations over a median 2.8 years of follow-up, according to the study. However, 33% of patients who received an intended dose intensity of 80% or higher were hospitalized for infection, analysis showed, compared with 23.3% of patients who received an intended dose intensity less than 80%. 

Some 51 patients died from infection. Cumulative incidences of infection-related death were 3.3% at 6 months, 5% at 12 months, 7.2% at 2 years, and 11.1% at 5 years, researchers reported. Patient factors independently associated with death from infection were an International Prognostic Index (IPI) score of 3 to 5, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score of 6 or higher, and low albumin. 

“We defined a smaller group (15%) of patients (IPI score of 0-2, albumin >36 g/L, CIRS-G score <6) in which no cases of infection-related deaths occurred at 5 years of follow-up,” researchers wrote. 

The study also found that infection-related admissions were decreased with primary quinolone prophylaxis. 

“Whether patients at higher risk of infection-related death could be targeted with enhanced antimicrobial prophylaxis remains unknown and will require a randomized trial,” researchers advised.

—Jolynn Tumolo

Reference:

Eyre TA, Wilson W, Kirkwood AA, et al. Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP. Blood Adv. 2021;5(8):2229-2236. doi:10.1182/bloodadvances.2021004286