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Chronic myeloproliferative neoplasms

Risk of infections in patients with myeloproliferative neoplasms—a population-based cohort study of 8363 patients

Leukemia volume 35, pages 476–484 (2021)Cite this article

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Abstract

Infections are a common complication in patients with many hematologic malignancies, however, whether patients with myeloproliferative neoplasms (MPN) also are at an increased risk of infections is largely unknown. To assess the risk of serious infections, we performed a large population-based matched cohort study in Sweden including 8 363 MPN patients and 32,405 controls using high-quality registers between the years 1992–2013 with follow-up until 2015. The hazard ratio (HR) of any infection was 2.0 (95% confidence interval 1.9–2.0), of bacterial infections 1.9 (1.8–2.0), and of viral infections 2.1 (1.9–2.3). One of the largest risk increases was that of sepsis, HR 2.6 (2.4–2.9). The HR of any infection was highest in primary myelofibrosis 3.7 (3.2–4.1), and significantly elevated in all MPN subtypes; 1.7 (1.6–1.8) in polycythemia vera and 1.7 (1.5–1.8) in essential thrombocythemia. There was no significant difference in risk of infections between untreated patients and patients treated with hydroxyurea or interferon-α during the years 2006–2013. These novel findings of an overall increased risk of infections in MPN patients, irrespective of common cytoreductive treatments, suggest the increased risk of infection is inherent to the MPN.

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Fig. 1: Cumulative incidense of infection.
Fig. 2: Hazard ratio of infection over time from MPN diagnosis.

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Funding

The regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, Blodcancerfonden, the Cancer Research Foundations of Radiumhemmet, Åke Olsson Foundation for Hematologic Research, and the Memorial Sloan Kettering Core Grant (P30 CA008748).

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Authors and Affiliations

  1. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden

    Anna Ravn Landtblom & Malin Hultcrantz

  2. Department of Medicine, Division of Hematology, Stockholm South Hospital, Stockholm, Sweden

    Anna Ravn Landtblom

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Therese M-L Andersson, Paul W Dickman & Nurgul Batyrbekova

  4. Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden

    Karin E Smedby & Sandra Eloranta

  5. Department of Hematology, University Hospital Linköping, Linköping, Sweden

    Jan Samuelsson

  6. Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Magnus Björkholm & Malin Hultcrantz

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  1. Anna Ravn Landtblom
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Contributions

Conception and design: Landtblom, Andersson, Hultcrantz. Collection and assembly of data: Landtblom, Andersson, Dickman, Smedby, Eloranta, Björkholm, Hultcrantz. Data analysis and interpretation: All authors. Manuscript writing: Landtblom, Andersson, Hultcrantz. Final approval of manuscript: All authors.

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Correspondence to Anna Ravn Landtblom or Malin Hultcrantz.

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Conflict of interest

Andersson, Smedby, Eloranta, and Björkholm are involved in an ongoing public-private real world evidence collaboration between Karolinska Institutet and Janssen Pharmaceuticals, however, the current project is not related to this collaboration. Hultcrantz has received honoraria from Intellisphere, LLC, not related to this project. The remaining authors declare no conflict of interest.

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Landtblom, A.R., Andersson, T.ML., Dickman, P.W. et al. Risk of infections in patients with myeloproliferative neoplasms—a population-based cohort study of 8363 patients. Leukemia 35, 476–484 (2021). https://doi.org/10.1038/s41375-020-0909-7

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