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Non-Hodgkin lymphoma patients on bendamustine face increased risk for common infections

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June 18, 2018

In patients with indolent non-Hodgkin lymphoma, or iNHL, treatment with bendamustine is associated with an increased risk for common and opportunistic infections compared with other chemotherapy regimens, researchers reported in Clinical Infectious Diseases.

“Bendamustine is a potent chemotherapy agent increasingly used to treat [iNHL],” wrote Monica Fung, MD clinical fellow in infectious diseases at the University of California, San Francisco, and colleagues. “While effective, it causes significant T-cell lymphopenia, which may increase risk of infection. We examined infectious complications associated with bendamustine-containing regimens among older patients with iNHL.”

Using national databases, Fung and colleagues identified 9,395 iNHL patients aged 65 and older who underwent chemotherapy from 2006 to 2013. They compared the baseline characteristics and incidence rates between patients who were treated with bendamustine therapy and those who were treated with other regimens.

At baseline, patients treated with bendamustine had more advanced clinical disease (47.6% vs. 39.8% with stage IV disease; P < .001), underwent more lines of chemotherapy (3.1 vs. 2.1 lines of chemotherapy; P < .001) and had higher rates of neutropenia (20.3% vs. 18.2%; P = .04), the researchers reported.

Treatment with bendamustine was associated with 2.71 mean infections per patient compared with 2.51 in patients not exposed to bendamustine (P = .008), according to Fung and colleagues. The most common infectious complications were bacterial infection not otherwise specified, sepsis, varicella zoster virus, candidiasis and bacterial pneumonia, they reported. Patients treated with bendamustine were more likely to develop bacterial pneumonia (10.5 vs. 6.2 per 100 person-years), cytomegalovirus (1.0 vs. 0.3), VZV (13.8 vs. 8.3) and histoplasmosis (0.4 vs. 0.1).

They experienced a longer median time from chemotherapy to infection (bacterial, 82 vs. 67 days; viral, 134 vs. 98 days; opportunistic, 106 vs. 75 days) and had higher cumulative incidences of fungal (RR = 1.23; P = .017), viral (RR = 1.82; P < .0001) and opportunistic infections (RR = 1.47; P < .0001).

In an adjusted analysis, an association persisted between bendamustine exposure and viral (HR 1.39; 95% CI, 1.17-1.64) and opportunistic (HR = 1.16; 95% CI, 1.02-1.33) infections, specifically CMV (HR = 3.98; 95% CI, 1.40-11.26) VZV (HR = 1.49; 95% CI, 1.18-1.89) and histoplasmosis (HR = 3.55; 95% CI, 1.10-11.42), Fung and colleagues reported.

Modeling showed increased hazards of all opportunistic infections (HR = 1.09; 95% CI, 1.07-1.11) and bacterial infections (HR = 1.09, 95% CI 1.08-1.11) with increasing lines of chemotherapy.
“Bendamustine exposure is associated with an increased risk of common and opportunistic infections in patients with iNHL,” Fung and colleagues wrote. “Further prospective investigation into the potential role of antimicrobial prophylaxis is needed in these patients.” – by Jennifer Byrne

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Disclosures: Fung reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.