Patients with cutaneous T-cell lymphoma (CTCL) have an increased risk of, and death from, sepsis as a result of immune dysregulation and concomitant recurrent skin infections. Infection prevention is a challenge for these patients, and guidelines for identifying patients at increased risk are lacking.

A group of researchers conducted a single-institution, retrospective cohort study to investigate clinical, demographic, and microbe-related features and survival outcomes of CTCL sepsis. They compared patients with CTCL sepsis, patients with non-CTCL non-Hodgkin lymphoma (NHL) who experienced at least 1 episode of sepsis, and a general population of patients with CTCL at that institution. Their findings were published in the Journal of the American Academy of Dermatology.

The researchers reviewed data from electronic health records of patients with CTCL and non-CTCL NHL and noted the presence of an episode of sepsis, systemic inflammatory response syndrome, or bacteremia. Causative microorganisms and captured data on age, race, ethnicity, cancer subtype, clinical disease stage, chemotherapy treatment, and history of stem cell transplant were assessed.


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The researchers found that patients with CTCL had a higher rate of overall readmission within 30 days of an inpatient sepsis episode, as well as higher death rates, than patients with non-CTCL NHL. Upon analysis of data from first sepsis to death, blood cultures positive for non-Staphylococcus microbes, Gram-negative microbes, and viremia or fungemia were associated with worse overall survival rates. Black patients were at “significantly greater risk” for sepsis, too.

Ultimately, clinicians must be aware of CTCL-specific risk factors for sepsis and allow that information to guide sepsis prevention efforts.

“The strategic use of targeted antimicrobial therapies (topical or systemic), plus efforts to repair the skin barrier and reconstitute a healthy cutaneous microbiome could reduce disease burden and modulate the likelihood of super infection and subsequent sepsis in these patients,” the researchers concluded.

Generalizability of the study results may be limited by its single-institution nature. Additionally, the applicability of the findings may be limited to mycosis fungoides (MF) and Sézary syndrome (SS) because 78% of the sepsis cohort had these most common CTCL subtypes, wrote the researchers. They also noted that evaluation of racial differences in CTCL should be essential in future research.

Reference

Hooper MJ, Veon FL, Enriquez GL, et al. Retrospective analysis of sepsis in cutaneous T-cell lymphoma reveals significantly greater risk in Black patients. J Am Acad Dermatol. Published online October 17, 2022. doi:10.1016/j.jaad.2022.10.029