摘要
目的:探讨住院期间使用新药(免疫调节药物、蛋白酶体抑制剂和单克隆抗体)治疗多发性骨髓瘤患者发生感染的临床特征及潜在的危险因素.方法:回顾性分析2017年3月1日至2022年3月1日山西白求恩医院血液科住院接受新药治疗(来那度胺、泊马度胺、硼替佐米、伊沙佐米、达雷妥尤单抗)的多发性骨髓瘤合并感染患者的临床特点及病原菌特征.感染被分为微生物学定义、临床定义和不明原因发热.单因素及多因素回归模型分析新药治疗多发性骨髓瘤合并感染的风险因素.结果:155例多发性骨髓瘤患者纳入本研究,中位随访时间为20个月.125例患者发生感染,感染例次为242次,感染中临床定义(CDI)的发生率最高(186例次,76.86％),其次为微生物感染(MDI)50例次(20.66％),不明原因的发热(FUF)为6例次(2.48％).微生物感染中细菌感染35例次(14.46％),病毒感染10例次(4.13％),真菌感染5例次(2.07％).最常见的感染部位为下呼吸道90例次(37.19％),其次为上呼吸道83例次(34.30％),消化道27例次(11.16％).多发性骨髓瘤合并新药治疗全因死亡率为8.39％(13/155).单因素分析结果显示,ISS分期Ⅲ期、治疗线数≥2及虚弱状态与多发性骨髓瘤发生感染相关.多因素回归分析结果显示,ISS分期Ⅲ期(OR=2.96,95％CI:1.19-7.40,P=0.02)、治疗线数≥2(OR=2.91,95％CI:1.13-7.51,P=0.03)和虚弱(OR=3.58,95％CI:1.44-8.89,P=0.01)是新药治疗多发性骨髓瘤患者出现感染的危险因素.结论:新药时代多发性骨髓瘤患者住院期间易合并细菌感染.ISS分期Ⅲ期、治疗线数≥2和虚弱状态是新药时代多发性骨髓瘤患者发生感染的危险因素.
Abstract
Objective:To evaluate the clinical characteristics and risk factors of infections occurring during hospitalization in patients with multiple myeloma (MM) treated with new generation therapies (including immuno-modulatory drugs,proteasome inhibitors and monoclonal antibodies).Methods:The clinical data were collected from 155 patients with multiple myeloma who were treated in Shanxi Bethune Hospital from March,2017 to March,2022 and were retrospectively analyzed.For this study,the following therapies were considered to be new generation therapies:lenalidomide,pomadomide,bortezomib,ixazomib,daratumumab. The clinical characteristics and risk factors of infection were analyzed.Results:A total of 155 patients were included in this study.The median follow-up time was 20 months.Of 155 patients with MM,242 infection episodes were identified.Among the 242 infections,the incidence of clinically defined infection (CDI)was the highest (186,76.86％),followed by microbiologically defined infection (MDI)in 50 cases (20.66％),and fever at unknown focus (FUF)in 6 cases (2.48％).35 cases (14.46％)of bacteria,10 cases (4.13％)of viruses,and 5 cases (2. 07％)of fungi were clearly infected.The most common site of infection was the lower respiratory tract in 90 cases (37.19％),the upper respiratory tract in 83 cases (34.30％),and the digestive tract in 27 cases (11.16％).All-cause mortality was 8.39％(13/155).In univariate analysis,there was a higher correlation between ISS stage Ⅲ,the number of treatment lines ≥2,frail and infected patients with multiple myeloma.In multivariate analysis,ISS stage Ⅲ(OR=2.96,95％CI:1.19-7.40,P=0.02),the number of treatment lines ≥2 (OR=2.91,95％CI:1.13-7.51,P=0.03)and frail (OR=3.58,95％CI:1.44-8.89,P=0. 01)were risk factors for infection in patients with multiple myeloma in the era of new drugs.Conclusion:Patients with multiple myeloma treated with new agents are prone to bacterial infection during hospitalization.ISS stage Ⅲ,lines of therapy(≥2)and frail were associated with high risk for infection.
维普
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