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Impaired Immune Health in Survivors of Diffuse Large B-Cell Lymphoma.

弥漫性大 B 细胞淋巴瘤幸存者的免疫健康受损。

  • 影响因子:11.08
  • DOI:10.1200/JCO.19.01937
  • 作者列表:"Shree T","Li Q","Glaser SL","Brunson A","Maecker HT","Haile RW","Levy R","Keegan THM
  • 发表时间:2020-02-21
Abstract

PURPOSE:Therapeutic advances for diffuse large B-cell lymphoma (DLBCL) have led to an increasing number of survivors. Both DLBCL and its treatments perturb the immune system, yet little is known about immune health during extended survivorship. METHODS:In this retrospective cohort study, we compared 21,690 survivors of DLBCL from the California Cancer Registry (CCR) to survivors of breast, prostate, head and neck, and melanoma cancers. We linked their CCR records to a statewide database documenting hospital, emergency room, and ambulatory surgery visits and investigated the incidence of autoimmune conditions, immune deficiencies, and infections 1-10 years after cancer diagnosis. RESULTS:We found elevated incidence rate ratios (IRRs) for many immune-related conditions in survivors of DLBCL compared with other cancer survivors, including significantly and consistently elevated IRRs for viral and fungal pneumonias (up to 10.8-fold), meningitis (up to 5.3-fold), as well as humoral deficiency (up to 17.6-fold) and autoimmune cytopenias (up to 12-fold). IRRs for most conditions remained high even in the late survivorship period (5-10 years after cancer diagnosis). The elevated risks could not be explained by exposure to chemotherapy, stem-cell transplantation, or rituximab, except for IRRs for humoral deficiency, which were consistently higher after the incorporation of rituximab into DLBCL treatments. CONCLUSION:To our knowledge, this is the largest cohort study with extended follow-up to demonstrate impaired immune health in survivors of DLBCL. The observed persistent, elevated risks for autoimmune diseases, immune deficiencies, and infectious conditions may reflect persistent immune dysregulation caused by lymphoma or treatment and may lead to excess morbidity and mortality during survivorship. Improved understanding of these risks could meaningfully improve long-term care of patients with DLBCL.

摘要

目的: 弥漫性大 b细胞淋巴瘤 (DLBCL) 的治疗进展导致越来越多的幸存者。DLBCL 及其治疗都会扰乱免疫系统,但对长期存活期间的免疫健康知之甚少。 方法: 在这项回顾性队列研究中,我们比较了来自加州癌症登记处 (CCR) 的 21,690 例 DLBCL 幸存者与乳腺癌、前列腺癌、头颈部和黑色素瘤幸存者。我们将他们的 CCR 记录与全州范围的数据库联系起来,记录医院、急诊室和门诊手术访视,并调查癌症诊断后 1-10 年的自身免疫状况、免疫缺陷和感染的发生率。 结果: 我们发现 DLBCL 幸存者与其他癌症幸存者相比,许多免疫相关疾病的发病率比率 (irr) 升高, 包括病毒和真菌性肺炎 (高达 10.8 倍) 、脑膜炎 (高达 5.3 倍) 以及体液缺乏 (高达 17.6 倍) 的 irr 显著和持续升高和自身免疫性血细胞减少(高达 12 倍)。即使在晚期存活期 (癌症诊断后 5-10 年),大多数情况下的 irr 仍然很高。升高的风险不能通过暴露于化疗、干细胞移植或利妥昔单抗来解释,除了体液缺陷的 irr,利妥昔单抗纳入 DLBCL 治疗后,irr 一直较高。 结论: 据我们所知,这是最大的队列研究,随访时间延长,证明 DLBCL 幸存者的免疫健康受损。观察到的自身免疫性疾病、免疫缺陷和感染性疾病的持续、升高的风险可能反映了淋巴瘤或治疗引起的持续免疫失调,并可能导致生存期间的超额发病率和死亡率。提高对这些风险的认识可以有意义地改善 DLBCL 患者的长期护理。

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影响因子:6.50
发表时间:2020-03-31
来源期刊:Cancer letters
DOI:10.1016/j.canlet.2019.12.039
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