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Invasive Fungal Disease in Patients with Chronic Lymphocytic Leukemia in Japan: A Retrospective Database Study
Takeo Yasu1, Kotono Sakurai1, Manabu Akazawa2
1Pharmaceutical Education and Research Center, Department of Medicinal Therapy Research, Meiji Pharmaceutical University, Noshio, Kiyose 204-8588, Japan.
Abstract:
Invasive fungal disease (IFD) is an important cause of morbidity and mortality in patients with hematological malignancies. As chronic lymphocytic leukemia (CLL) is a rare hematological malignancy in Japan, IFD incidence in Japanese patients with CLL is unclear. This study aimed to investigate IFD incidence in Japanese patients with CLL. This retrospective cohort study used data of patients with CLL registered between April 2008 and December 2019 in the Medical Data Vision database (n = 3484). IFD incidence after CLL diagnosis in the watch-and-wait (WW) and drug therapy (DT) groups was 1.5% and 9.2%, respectively. The most common type of IFD was invasive aspergillosis (28.1%). Cox proportional hazards multivariate analysis revealed that DT (hazard ratio [HR]: 2.13) and steroid use (HR: 4.19) were significantly associated with IFD occurrence. IFD incidence was significantly higher in the DT group than in the WW group (log-rank p < 0.001); however, there was no significant between-group difference in the time to IFD onset or the type of IFD (p = 0.09). This study determined the incidence of IFD in patients with CLL during WW. Physicians should monitor for IFD, even among patients with CLL undergoing the WW protocol.
Insights
Invasive fungal disease (IFD) is a risk for chronic lymphocytic leukemia (CLL) patients, especially those on drug therapy. Monitoring for IFD is crucial even in watch-and-wait patients.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Invasive fungal disease (IFD) significantly contributes to morbidity and mortality in hematological malignancy patients.
- Chronic lymphocytic leukemia (CLL) is uncommon in Japan, leaving IFD incidence in Japanese CLL patients largely unknown.
Purpose of the Study:
- To determine the incidence of IFD in Japanese patients diagnosed with CLL.
- To compare IFD incidence between watch-and-wait (WW) and drug therapy (DT) groups in CLL patients.
Main Methods:
- Retrospective cohort study utilizing the Medical Data Vision database (April 2008 - December 2019).
- Analysis included 3484 patients with CLL, comparing IFD incidence between WW and DT groups.
- Cox proportional hazards multivariate analysis identified risk factors for IFD.
Main Results:
- IFD incidence was 1.5% in the WW group and 9.2% in the DT group.
- Invasive aspergillosis was the most common IFD (28.1%).
- Drug therapy (HR: 2.13) and steroid use (HR: 4.19) were significant risk factors for IFD. IFD incidence was significantly higher in the DT group (p < 0.001).
Conclusions:
- This study establishes IFD incidence in Japanese CLL patients, highlighting a higher risk in those receiving drug therapy.
- Physicians should maintain vigilance for IFD in all CLL patients, including those managed with watch-and-wait.
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