Invasive fungal infections (IFI) represent a clinically important complication in patients with haematological malignancies. This retrospective cohort study of adults with mature T‑cell and NK‑cell lymphomas (T/NKCL) enrolled cases from 2019 through 2024 to define the epidemiology and outcomes of IFI in this underreported population. The authors applied the 2020 EORTC/MSGERC criteria to classify proven and probable IFI and used multivariable models to identify predictors of IFI and of death.
The analysis included 203 adult patients with T/NKCL. IFI episodes were adjudicated according to the 2020 EORTC/MSGERC definitions for proven and probable invasive fungal disease. The investigators used multivariable logistic regression to determine factors independently associated with the occurrence of IFI and with all‑cause mortality. An adjusted time‑dependent Cox proportional hazards model was used to examine the association between IFI and survival over time. The abstract does not provide further granular details on patient selection criteria, antifungal prophylaxis practices, laboratory methods, or antifungal treatments.
Among the 203 patients, 43 (21%) developed at least one IFI, totaling 52 IFI episodes. The breakdown by broad pathogen category was: 22 invasive yeast infections (IYI), 15 invasive mould infections (IMI), and 15 episodes of Pneumocystis jirovecii pneumonia (PCP). Eight patients experienced multiple IFI episodes. These results indicate that about one in five patients with mature T/NKCL in this cohort had a clinically significant IFI event during the study interval.
The median time from lymphoma diagnosis or cohort entry to IFI onset differed by pathogen group. Median time to onset was 128 days for invasive yeast infections, 455 days for invasive mould infections, and 62 days for PCP. These pathogen‑specific timeframes suggest distinct windows of vulnerability: PCP tended to present earlier, IMI later, and IYI at an intermediate interval. The abstract does not specify whether timing is measured from diagnosis, start of therapy, or another index date, only reporting the median times to IFI onset.
In multivariable logistic regression analysis, several factors were independently associated with higher odds of developing IFI:
Achievement of disease remission was associated with a reduced risk of IFI (aOR 0.36; 95% CI 0.15–0.81). The abstract does not report other univariable predictors, the full list of covariates included in the models, or absolute risk differences for subgroups.
IFI were strongly associated with poorer outcomes. IFI was an independent predictor of all‑cause mortality in multivariable logistic regression (aOR 6.33; 95% CI 2.46–17.83). In a time‑dependent Cox model adjusted for covariates, IFI remained independently associated with reduced survival (adjusted hazard ratio [aHR] 9.53; 95% CI 5.79–15.68). These effect estimates indicate a substantial adverse impact of IFI on survival in this cohort of T/NKCL patients.
The findings highlight that IFI are common (21% incidence) and confer a marked mortality risk among patients with mature T‑cell and NK‑cell lymphomas. The pathogen‑specific timing — earlier for PCP, later for mould infections — supports the need for time‑aware risk stratification in clinical practice. The independent associations with male sex, advanced Ann Arbor stage, gastrointestinal bleeding, and haematopoietic stem cell transplantation can inform identification of higher‑risk patients who might benefit from targeted monitoring or prophylactic interventions.
The authors conclude these data support early risk stratification and implementation of targeted preventive strategies in this high‑risk population. The abstract does not provide specific recommendations for prophylaxis agents, diagnostic screening frequency, or treatment algorithms.
The summary provided in the abstract is concise and omits several methodological and contextual details. The abstract does not report: precise inclusion/exclusion criteria, whether and which antifungal prophylaxis was used, species‑level microbiology beyond broad categories, management strategies for IFI, or subgroup survival curves. Additional limitations, sensitivity analyses, and external validity considerations are not detailed in the abstract and therefore were not available for extraction from the source.
In adults with mature T/NKCL, IFI occurred in about one‑fifth of patients and were associated with a large increase in mortality. Distinct median times to infection for PCP, IYI, and IMI suggest different windows for surveillance and prevention. Recognizing the identified risk factors and prioritizing early risk stratification and targeted prevention were the study’s principal clinical implications as stated by the authors.