Pneumonia in patients with chronic lymphocytic leukemia treated with venetoclax‐based regimens: A real‐world analysis of Polish Adult Leukemia Group (PALG)
Elżbieta Kalicińska,
Paula Jablonowska‐Babij,
Marta Morawska,
Elżbieta Iskierka‐Jażdżewska,
Joanna Drozd‐Sokolowska,
Ewa Paszkiewicz‐Kozik,
Łukasz Szukalski,
Judyta Strzała,
Urszula Gosik,
Jakub Dębski,
Iga Andrasiak,
Anna Skotny,
Krzysztof Jamroziak,
Tomasz Wrobel
Affiliations
Elżbieta Kalicińska
Clinical Department of Hematology, Cell Therapies and Internal Diseases Wroclaw Medical University Wroclaw Poland
Paula Jablonowska‐Babij
Clinical Department of Hematology, Cell Therapies and Internal Diseases Wroclaw Medical University Wroclaw Poland
Marta Morawska
Experimental Hematooncology Department Medical University of Lublin Lublin Poland
Elżbieta Iskierka‐Jażdżewska
Department of General Hematology Medical University of Lodz Lublin Poland
Joanna Drozd‐Sokolowska
Department of Hematology, Transplantation and Internal Medicine Medical University of Warsaw Warsaw Poland
Ewa Paszkiewicz‐Kozik
Department of Lymphoid Malignancies National Research Institute of Oncology Warsaw Poland
Łukasz Szukalski
Department of Hematology Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń Toruń Poland
Judyta Strzała
Department of Hematology and Bone Marrow Transplantation Pomeranian Hospitals in Gdynia Gdynia Poland
Urszula Gosik
Department of Hematology St. John's Cancer Center in Lublin Lublin Poland
Jakub Dębski
Department of Hematology Provincial Specialist Hospital in Legnica Legnica Poland
Iga Andrasiak
Independent Researcher Wroclaw Poland
Anna Skotny
Harvard T.H. Chan School of Public Health ‐ ECPE Boston Massachusetts USA
Krzysztof Jamroziak
Department of Hematology, Transplantation and Internal Medicine Medical University of Warsaw Warsaw Poland
Tomasz Wrobel
Clinical Department of Hematology, Cell Therapies and Internal Diseases Wroclaw Medical University Wroclaw Poland
Abstract Background Patients with chronic lymphocytic leukemia (CLL) are susceptible to infections that can affect their clinical outcomes. Aims To assess: (1) the incidence of pneumonia in CLL patients treated with venetoclax‐based regimens in a real‐world setting, (2) the risk factors for event‐free survival (EFS), and (3) overall survival (OS). Methods This multicenter study included 322 patients from eight centers. Univariable and multivariable analyses (MVA) were performed, having the development of pneumonia during venetoclax‐based treatment and OS as outcomes. Results The most common complication was neutropenia (59%). During treatment with venetoclax‐based regimens, 66 (20%) of patients developed pneumonia: 50 (23%) patients in the rituximab plus venetoclax (R‐VEN) group, 13 (16%) patients in the obinutuzumab plus venetoclax (O‐VEN) group (p = 0.15). Chronic obstructive pulmonary disease (COPD)/asthma, splenomegaly, elevated creatinine, and anemia <8 g/dL were the risk factors for EFS in MVA (hazard ratio [HR] = 2.08, 95% confidence interval [CI], 1.16–3.74, p = 0.014; HR 1.73, 95% CI, 1.08–2.78, p = 0.02; HR 2.13, 95% CI, 1.10–4.11, p = 0.03, HR 3.58, 95% CI, 2.18–5.89, p < 0.001, respectively). Relapsed/refractory (R/R) CLL patients treated with R‐VEN with pneumonia had worse OS than those without (p < 0.001). In patients treated with O‐VEN, median OS did not differ between patients with and without pneumonia (p = 0.45). Conclusions Our real‐world study showed that pneumonia during venetoclax treatment occurs more frequently than reported in registration trials and has a negative impact on OS, especially in patients with R/R CLL treated with R‐VEN. Neutropenia is not a risk factor for pneumonia.
