title: Risk factors for infections in myelofibrosis: role of disease status and treatment. A multicenter study of 507 patients.
abstract: Although infectious complications represent a relevant cause of morbidity and mortality in patients with myelofibrosis (MF), little is known about their incidence, outcome and risk factors. We retrospectively evaluated a cohort of 507 MF patients, diagnosed between 1980 and 2014 in five Italian hematology centers, to define the epidemiology of infections and describe the impact of ruxolitinib (RUX) treatment. Overall, 112 patients (22%) experienced 160 infectious events (grade 3-4, 45%) for an incidence rate of 3.9% per patient-year. Infections were mainly bacterial (78%) and involving the respiratory tract (52% of cases). Also, viral (11%) and fungal infections (2%) were recorded. Overall, infections were fatal in 9% of the cases. Among baseline features, high/intermediate-2 IPSS category (HR 1.8, 95%CI:1.2-2.7; P = 0.02) and spleen length ≥10 cm below left costal margin (HR 1.6, 95%CI:1.1-2.5; P = 0.04) were associated with higher infectious risk in multivariate analysis. Overall, the rate of infections was higher in the cohort of 128 RUX-treated patients (44% vs. 20%, P < 0.001). In conclusion, IPSS-category and splenomegaly, emerged as the main risk factors for infections in MF. RUX-treated patients experienced significantly more infection episodes; however, future prospective studies are needed to isolate the confounding contribution of other risk factors such as disease stage. Am. J. Hematol. 92:37-41, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Polverelli
authors.affiliation: Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.affiliation: Hematology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Benevolo
authors.affiliation: Division of Hematology, Azienda Ospedaliera 'Bianchi Melacrino Morelli', Reggio Calabria, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Martino
authors.affiliation: Division of Hematology, Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Tieghi
authors.affiliation: Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latagliata
authors.affiliation: Haematopathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna.
authors.forename: Elena
authors.initials: E
authors.lastname: Sabattini
authors.affiliation: Haematopathology Unit, Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Riminucci
authors.affiliation: Anatomia Patologica Generale e Oncogenetica Molecolare, Città della Salute e della Scienza Hospital and University, Torino, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Godio
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Catani
authors.affiliation: Hematology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Nicolosi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Perricone
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Daria
authors.initials: D
authors.lastname: Sollazzo
authors.affiliation: Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy.
authors.forename: Gioia
authors.initials: G
authors.lastname: Colafigli
authors.affiliation: Hematology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Campana
authors.affiliation: Division of Hematology, Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Merli
authors.affiliation: Hematology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.affiliation: Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Alimena
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinelli
authors.affiliation: Division of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Vianelli
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Palandri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003141:Communicable Diseases / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D005260:Female; D006801:Humans; D015994:Incidence; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D055728:Primary Myelofibrosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D009570:Nitriles; D011720:Pyrazoles; D011743:Pyrimidines; C540383:ruxolitinib; C507924:JAK2 protein, human; D053614:Janus Kinase 2