Poor outcome and high prevalence of invasive fungal infections in patients with adult T-cell leukemia/lymphoma exposed to zidovudine and interferon ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2021-08-13

AUTHORS

Romain Guery, Felipe Suarez, Fanny Lanternier, Marie Elisabeth Bougnoux, Hervé Lecuyer, Véronique Avettand-Fenoel, David Sibon, Laurent Frenzel, Jean-Herlé Raphalen, Philippe Helias, Philippe Renaudier, Florin Santa, Marc Lecuit, Olivier Lortholary, Olivier Hermine, Claire Aguilar, Ambroise Marçais

ABSTRACT

Patients treated for adult T-Cell leukemia/lymphoma (ATL) have a poor prognosis and are prone to infectious complications which are poorly described. As the French reference center for ATL, we retrospectively analyzed 47 consecutive ATL (acute, n = 23; lymphoma, n = 14; chronic, n = 8; smoldering, n = 2) patients between 2006 and 2016 (median age 51 years, 96% Afro-Caribbean origin). The 3-year overall survival (OS) was 15.8%, 11.3%, and 85.7% for acute, lymphoma, and indolent (chronic and smoldering) forms respectively. Among aggressive subtypes, 20 patients received, as frontline therapy, high dose of zidovudine and interferon alfa (AZT-IFN⍺) resulting in an overall response rate (ORR) of 39% (complete response [CR] 33%) and 17 chemotherapy resulting of an ORR of 59% (CR 50%). Ninety-five infections occurred in 38 patients, most of whom had an acute subtype (n = 73/95; 77%). During their follow-up, patients receiving frontline chemotherapy or frontline AZT-IFNα developed infections in 74% (n = 14/19) and 89% (n = 24/27) of the cases respectively. Sixty-four (67%) of infections were microbiologically documented. Among them, invasive fungal infections (IFI, n = 11) included 2 Pneumocystis jirovecii pneumonia, 5 invasive aspergillosis, and 4 yeast fungemia. IFI exclusively occurred in patients with acute subtype mostly exposed to AZT-IFNα (n = 10/11) and experiencing prolonged (> 10 days) grade 4 neutropenia. Patients with aggressive subtype experiencing IFI had a lower OS than those who did not (median OS 5.4 months versus 18.4 months, p = 0.0048). ATL patients have a poor prognosis even in the modern era. Moreover, the high rate of infections impacts their management especially those exposed to AZT-IFNα. More... »

PAGES

2813-2824

Journal

TITLE

Annals of Hematology

ISSUE

11

VOLUME

100

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00277-021-04622-9

DOI

http://dx.doi.org/10.1007/s00277-021-04622-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1140406117

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34387741


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