Incidence of Infectious Complications in Patients with Non-Hodgkin Lymphoma Receiving Rituximab-containing Chemotherapy

Abstract

Background. Rituximab, a monoclonal antibody against CD20+ cells, produces a fast depletion of B cells. It also has citotoxic effects on T cells, late-onset neutropenia. and hypoggamaglobulinemia. It increases the risk of hepatitis B reactivation and has also been associated with the development of opportunistic infections. Methods. Retrospective, single-center, observational and analytical study that included patients diagnosed with non-Hodgkin lymphoma (NHL) from January 1, 2011, to December 31, 2012, at Instituto Nacional de Cancerología (INCan) in Mexico City. Demographics, outcomes, and infections grade 3 to 5 (Common Terminology Criteria for Adverse Events version 4.0, NCI, NIH) were registered on a standardized data form. Infectious complications were described, and incidence was calculated. Results. Two hundred and sixty-five patients with NHL were included; 85 (32%) developed an infectious complication, infection rate was 0.87 per 1,000 person/days. There were 177 events in the 85 patients. Forty-two patients (49%) had more than one event. Most common infections were: febrile neutropenia (n = 38, 21.5%); mucosal barrier injury related (n = 28, 15.8%); urinary tract infections (n = 19, 10.7%); pneumonia (n = 38, 21.5%); skin and soft tissue infections (n = 17, 9.6%); abdominal sepsis (n = 12, 6.8%); central line-associated bloodstream infection (n = 16, 9%) and meningitis (n = 2, 1.1%). In 88 (49%) of the events there was a microbiologic diagnosis: 70 (39.5%) bacteria, 4 (2.3%) mycobacterium, 4 (2.3%) fungus, 9 (5.1%) virus, and 1 (0.6%) parasite. The incidence rate of tuberculosis was 721 per 100,000 person-years. There were no hepatitis B reactivations, although there were 6 patients with anti-core antibodies positive that do not received preemptive antiviral treatment. The median hospital stay for patients with an infection event was 6 (1-58) days. Thirty-five events (19.7%) contributed directly to death; pneumonia accounted for 14 (40%) of these events. Conclusion. The incidence rate of tuberculosis in this population was 41 times higher than that reported in the general population in Mexico. Strategies must be implemented to diagnose and treat latent tuberculosis and to include amongst the differential diagnosis TB, favoring an appropriate and early treatment.