Patients with indolent lymphomas are at high risk of infections - Experience from a German outpatient clinic

Background: Patients with indolent B-cell non-Hodgkin lymphomas (B-NHL) have an increased risk of infection which is caused by pathomechanisms of the diseases itself but also as a result of anti-tumor therapy. Especially the effects of anti-CD20 antibodies are well understood as these lead to decreased antibody production.Most analyses regarding this issue were performed in studies with multiple myeloma and chronic lymphocytic leukemia patients. As these studies not always represent the general population we collected real life data from 227 patients with indolent lymphomas undergoing therapy or who were regularly monitored in a watch and wait approach over the time of one year. As control we collected data from an age and sex matched control group of 145 persons. Results: Patients with B-NHLs had an increased rate of infection that was detectable in all subgroups. Consistent with this finding B-NHL patients received more antibiotic treatment and were more often hospitalized than patients from the control group. Lymphoma patients without immunodeficiency had a significantly lower infection rate than patients with immunodeficiency but it was still significantly higher compared to the control group. Patients with symptomatic immunodeficiency were mostly treated with regular immunoglobulin infusions and infection rates were comparable to those of patients with asymptomatic immunodeficiency. Conclusions: Our data suggest an approach with regular immune monitoring of all indolent lymphoma patients in order to identify patients with increased risk of infections. It also raises the question if patients with immunodeficiency should be treated more often with regular immunoglobulin infusion, but so far more studies are necessary to answer this question.