Incidence and risk factors of severe infections in diffuse large B-cell lymphoma patients undergoing immunochemotherapy

To determine the incidence and risk factors of severe infection (SI) in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab-chemotherapy (R-C). This retrospective study was conducted at a tertiary care center in China. Patients with newly diagnosed DLBCL who were treated with R-C between January 1, 2022, and July 1, 2023, at our center were included in this study. SI was defined as an infection resulting in hospitalization. COVID-19 infections were excluded from the study. Patients were categorized as having SI or not by analyzing clinical data, comparing the characteristics of the two groups, and exploring the independent risk factors for SI using multivariate logistic analyses. A total of 300 patients were enrolled in this study, with a male-to-female ratio of 1:1.03 and a median age of 62 years (range: 20-88 years). A total of 117 patients (39.0%) developed SIs, with most (86.3%) occurring within six months of the first treatment. One-third of the infections were identified as opportunistic. Advanced stage disease (OR 2.814, 95% CI 1.603-4.939, P < 0.001), smoking history (OR 9.379, 95% CI 3.901-22.547, P < 0.001), concomitant autoimmune diseases (OR 3.730, 95% CI 1.349-10.311, P = 0.011), dexamethasone equivalent dose ≥ 15 mg/d (OR 2.436, 95% CI 1.213-4.894, P = 0.012) and prophylactic treatment with granulocyte-stimulating factors (OR 0.319, 95% CI 0.178-0.574, P < 0.001) were independently associated with the development of SI in DLBCL patients receiving R-C. Infection is a relatively common complication following R-C treatment in patients with DLBCL. Independent risk factors for SI were identified, which may aid clinicians in developing individualized infection prevention and treatment strategies.