Characteristics of pulmonary complications in non-Hodgkin’s lymphoma patients treated with rituximab-containing chemotherapy and impact on survival

Kimberly Keefer, Regis Bender, Jiangang (Jason) Liao, Jeffrey Sivik, Andry Van De Louw

Research output: Contribution to journalArticle

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Abstract

Patients with non-Hodgkin’s lymphoma (NHL) receiving rituximab-containing chemotherapy are at risk of developing respiratory complications, but comprehensive information on these complications and their impact on survival is lacking. We performed a retrospective cohort analysis on 123 NHL patients who received rituximab-containing chemotherapy between 2009 and 2016 in order to describe the incidence, etiologies and effect on survival of respiratory complications defined by new or worsening respiratory symptoms requiring diagnostic work-up or hospitalization. Thirty patients (24%) developed respiratory complications during a follow-up time of 825 (555–1338) days after chemotherapy. They had a higher prevalence of congestive heart failure and lung or pleural involvement at diagnosis as compared to patients who did not develop complications. Overall, 58 episodes of pulmonary complications were observed after median (interquartile) times from the first and last rituximab doses of 205 (75–580) days and 27 (14–163) days respectively. Infectious etiologies accounted for 75% of the respiratory complications, followed by heart failure exacerbation, lymphomatous involvement, and ARDS. Two Pneumocystis jirovecii pneumonias were observed, and no complication was ascribed to rituximab toxicity. Respiratory complications required ICU admission in 19 cases (33%) and invasive mechanical ventilation in 14 cases (24%). Using a time-dependent Cox regression analysis, we observed that the occurrence of respiratory complications was associated with a 170% increase in death hazard (hazard ratio 2.65, 95% CI 1.60–4.40, p = 0.001). In conclusion, respiratory complications in NHL patients receiving chemotherapy are relatively frequent, severe, and mostly infectious and are associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)2373-2380
Number of pages8
JournalAnnals of Hematology
Volume97
Issue number12
DOIs
StatePublished - Dec 1 2018

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Non-Hodgkin's Lymphoma
Drug Therapy
Lung
Survival
Heart Failure
Pneumocystis carinii
Pneumocystis Pneumonia
Artificial Respiration
Hospitalization
Cohort Studies
Regression Analysis
Rituximab
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

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title = "Characteristics of pulmonary complications in non-Hodgkin’s lymphoma patients treated with rituximab-containing chemotherapy and impact on survival",
abstract = "Patients with non-Hodgkin’s lymphoma (NHL) receiving rituximab-containing chemotherapy are at risk of developing respiratory complications, but comprehensive information on these complications and their impact on survival is lacking. We performed a retrospective cohort analysis on 123 NHL patients who received rituximab-containing chemotherapy between 2009 and 2016 in order to describe the incidence, etiologies and effect on survival of respiratory complications defined by new or worsening respiratory symptoms requiring diagnostic work-up or hospitalization. Thirty patients (24{\%}) developed respiratory complications during a follow-up time of 825 (555–1338) days after chemotherapy. They had a higher prevalence of congestive heart failure and lung or pleural involvement at diagnosis as compared to patients who did not develop complications. Overall, 58 episodes of pulmonary complications were observed after median (interquartile) times from the first and last rituximab doses of 205 (75–580) days and 27 (14–163) days respectively. Infectious etiologies accounted for 75{\%} of the respiratory complications, followed by heart failure exacerbation, lymphomatous involvement, and ARDS. Two Pneumocystis jirovecii pneumonias were observed, and no complication was ascribed to rituximab toxicity. Respiratory complications required ICU admission in 19 cases (33{\%}) and invasive mechanical ventilation in 14 cases (24{\%}). Using a time-dependent Cox regression analysis, we observed that the occurrence of respiratory complications was associated with a 170{\%} increase in death hazard (hazard ratio 2.65, 95{\%} CI 1.60–4.40, p = 0.001). In conclusion, respiratory complications in NHL patients receiving chemotherapy are relatively frequent, severe, and mostly infectious and are associated with increased mortality.",
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Characteristics of pulmonary complications in non-Hodgkin’s lymphoma patients treated with rituximab-containing chemotherapy and impact on survival. / Keefer, Kimberly; Bender, Regis; Liao, Jiangang (Jason); Sivik, Jeffrey; Van De Louw, Andry.

In: Annals of Hematology, Vol. 97, No. 12, 01.12.2018, p. 2373-2380.

Research output: Contribution to journalArticle

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T1 - Characteristics of pulmonary complications in non-Hodgkin’s lymphoma patients treated with rituximab-containing chemotherapy and impact on survival

AU - Keefer, Kimberly

AU - Bender, Regis

AU - Liao, Jiangang (Jason)

AU - Sivik, Jeffrey

AU - Van De Louw, Andry

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