Epidemiology and outcomes of invasive fungal infections in patients with mature T-cell and NK-cell lymphomas.
Invasive fungal infections are common and significantly increase mortality risk in patients with mature T-cell and NK-cell lymphomas.
Where it sits
this study against the rest of the melanotan i (mt-i) corpusSummary and findings
This study evaluated the incidence and outcomes of invasive fungal infections (IFI) in adult patients with mature T-cell and NK-cell lymphomas. Among 203 patients, 43 (21%) developed 52 episodes of IFI. The study identified various risk factors associated with IFI and mortality.
Abstract
<h4>Background</h4>Invasive fungal infection (IFI) causes poor outcomes in haematological malignancies, but data in mature T-cell and NK-cell lymphomas (T/NKCL) are scarce. We aimed to define epidemiology and outcomes of IFI in this population.<h4>Materials and methods</h4>This retrospective study enrolled adult patients with T/NKCL between 2019 and 2024. Proven and probable IFI were defined according to the 2020 EORTC/MSGERC criteria. Multivariable logistic regression was used to identify factors associated with IFI and death.<h4>Results</h4>Among 203 patients, 43 (21%) developed 52 IFI episodes, including invasive yeast infections (IYI, <i>n</i> = 22), invasive mould infections (IMI, <i>n</i> = 15), and Pneumocystis jirovecii pneumonia (PCP, <i>n</i> = 15); eight patients experienced multiple episodes. Median time to IFI onset was 128 days for IYI, 455 days for IMI, and 62 days for PCP. In multivariable analysis, IFI was independently associated with male gender (aOR 3.22; 95% CI 1.32-8.72), high lymphoma Ann Arbor stage (aOR 3.58; 95% CI 1.46-9.75), gastrointestinal bleeding (aOR 11.32; 95% CI 2.61-57.13), and haematopoietic stem cell transplantation (aOR 5.96; 95% CI 2.51-14.67), while achievement of disease remission was associated with a reduced risk (aOR 0.36; 95% CI 0.15-0.81). IFI was an independent predictor of all-cause mortality (aOR 6.33, 95% CI 2.46-17.83) in multivariable analysis. In the adjusted time-dependent Cox model, IFI remained independently associated with lower survival (aHR, 9.53; 95% CI, 5.79-15.68).<h4>Conclusions</h4>IFI is common and confers substantial mortality in patients with T/NKCL, with distinct pathogen-specific timing. These findings support early risk stratification and targeted preventive strategies in this high-risk population.
Background
Invasive fungal infections (IFI) are known to adversely affect outcomes in patients with hematological malignancies, but specific data regarding mature T-cell and NK-cell lymphomas (T/NKCL) are limited. Previous studies have indicated a high risk of IFI in immunocompromised populations, yet the epidemiology and outcomes in T/NKCL patients remain underexplored. This study aims to fill that gap by defining the incidence and risk factors for IFI in this specific patient population.
Methods
This retrospective study included adult patients diagnosed with T/NKCL from 2019 to 2024. A total of 203 patients were enrolled, and IFI was classified based on the 2020 EORTC/MSGERC criteria. Multivariable logistic regression was employed to identify factors associated with the development of IFI and mortality.
Results
Among 203 patients, 43 (21%) developed 52 episodes of IFI. The median time to onset was 128 days for invasive yeast infections, 455 days for invasive mould infections, and 62 days for Pneumocystis jirovecii pneumonia. In multivariable analysis, male gender, high lymphoma Ann Arbor stage, gastrointestinal bleeding, and haematopoietic stem cell transplantation were associated with increased risk of IFI, while disease remission was associated with a reduced risk. IFI was found to be an independent predictor of all-cause mortality.
Interpretation
The findings suggest that IFI is prevalent and significantly impacts mortality in patients with T/NKCL. The effect sizes reported, particularly the aOR of 6.33 for mortality, indicate a strong association, although the clinical significance may vary based on individual patient factors. Limitations include the retrospective nature of the study and potential confounding variables that could affect the outcomes. These results underscore the need for early risk stratification and preventive measures in this vulnerable population.
Key findings
- 21% of patients developed 52 IFI episodes, n=203.
- Median time to IFI onset was 128 days for invasive yeast infections, 455 days for invasive mould infections, and 62 days for Pneumocystis jirovecii pneumonia.
- IFI was independently associated with male gender (aOR 3.22; 95% CI 1.32-8.72).
- IFI was an independent predictor of all-cause mortality (aOR 6.33; 95% CI 2.46-17.83).
- In the adjusted time-dependent Cox model, IFI was associated with lower survival (aHR 9.53; 95% CI 5.79-15.68).
Limitations
- Retrospective study design.
- Potential confounding factors inherent to observational studies.
- Single-center data may limit generalizability.
- No information on treatment regimens or supportive care.