THE INCIDENCE OF INTERSTITIAL PNEUMONIA IN NEWLY TREATED DIFFUSE LARGE B‐CELL LYMPHOMA PATIENTS DURING THE COVID‐19 PANDEMIC: A SINGLE‐CENTER, RETROSPECTIVE ANALYSIS OF CONSECUTIVE CASES

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Background: During 2020-2022, the COVID-19 pandemic has had a significant impact on overall medical management and the daily life of people in China. With the popularization of chest CT screening before admission to hospital, we can detect interstitial pneumonia in a more timely and accurate rate. Previous studies reported that the incidence of interstitial pneumonia (IP) caused by rituximab treatment was 3.7% to 16.7%, while the combination of rituximab and liposomal doxorubicin (R-CDOP) resulted in 28.95% incidence of IP. Purpose: A total of 121 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients admitted to the Department of Hematology of Beijing Tongren Hospital from January 2020 to December 2022 were included in this single-center, retrospective analysis. All patients were treated with R-CHOP or R-CDOP. The incidence of treatment-related IP in DLBCL patients during the epidemic period and its correlation with clinical features were determined by chest CT screening before admission and mid-term PET-CT evaluation. Method: All patients received R-CHOP (rituximab 375 mg/㎡ d0, cyclophosphamide 750 mg/㎡,d1, doxorubicin 50 mg/㎡,d1, vindesine 3 mg/㎡,d1, prednisone 60 mg/㎡ D1-5) or R-CDOP (liposomal doxorubicin 40 mg/㎡, maximum 60 mg, in replace of doxorubicin);R-miniCHOP or miniCDOP was used in patients older than 70 years old. The baseline clinical and pathological characteristics were collected. The occurrence of IP was evaluated by chest CT or PET-CT examination. The short-term response rate (ORR or CR rate) was determined according to the modified Lugano response evaluation criteria. Results: Twenty-three of 121 patients developed IP during treatment, with an overall incidence of 19%. The median time to occurrence of IP was after about 4 cycles of rituximab, and the median duration of treatment for IP was 8 days. A total of 15 patients received steroids-containing regimens for IP, 16 patients terminated rituximab treatment after the onset of IP, and 7 patients stopped liposomal doxorubicin. All patients with IP recovered after treatment. The incidence of IP was increased in patients treated with liposomal doxorubicin containing regimen (27.3 % vs. 14.3 %, P = 0.080), smoking (25.8 % vs. 16.7%, P = 0.263), advanced age (22.8 % vs. 11.9%, P = 0.146) and underlying disease (20.0% vs. 16.1%, P = 0.636) were associated with a higher incidence of IP. After R-CHOP or R-CDOP treatments, the CR rate of all patients reached 49.6% in the interim response evaluation, and 75.2% in the final evaluation. Compared with full-dose R-CHOP regimen, the rate of end-of-treatment CR rate increased from 70.0% to 82.1% and the incidence of IP increased from 16.4% to 30.0% with full-dose R-CDOP. Conclusion: The occurrence of interstitial pneumonia should be vigilant after rituximab-containing treatments in patients with diffuse large B-cell lymphoma, especially in those with smoking, old age and underlying diseases. The prevention and monitoring of interstitial pneumonia should be strengthened after the application of liposomal doxorubicin. The research was funded by: This work was supported by grants from the National Natural Science Foundation of China (grant No. 81873450, 82170181), Beijing Hospitals Authority Youth Programme (code: QML20200201), and Beijing Natural Science Foundation (No. 7222027) to Liang Wang Keywords: Aggressive B-cell non-Hodgkin lymphoma, Chemotherapy, Prevention and Cancer Interception No conflicts of interests pertinent to the abstract.

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