Epidemiology and outcomes of invasive fungal infections in patients with mature T-cell and NK-cell lymphomas

Abstract

Abstract Background Invasive fungal infection (IFI) causes poor outcomes in haematological malignancies, but data in mature T-cell and NK-cell lymphomas (T/NKCL) are scarce. We aimed to define epidemiology and outcomes of IFI in this population. Materials and methods This retrospective study enrolled adult patients with T/NKCL between 2019 and 2024. Proven and probable IFI were defined according to the 2020 EORTC/MSGERC criteria. Multivariable logistic regression was used to identify factors associated with IFI and death. Results Among 203 patients, 43 (21%) developed 52 IFI episodes, including invasive yeast infections (IYI, n = 22), invasive mould infections (IMI, n = 15), and Pneumocystis jirovecii pneumonia (PCP, n = 15); eight patients experienced multiple episodes. Median time to IFI onset was 128 days for IYI, 455 days for IMI, and 62 days for PCP. In multivariable analysis, IFI was independently associated with male gender (aOR 3.22; 95% CI 1.32–8.72), high lymphoma Ann Arbor stage (aOR 3.58; 95% CI 1.46–9.75), gastrointestinal bleeding (aOR 11.32; 95% CI 2.61–57.13), and haematopoietic stem cell transplantation (aOR 5.96; 95% CI 2.51–14.67), while achievement of disease remission was associated with a reduced risk (aOR 0.36; 95% CI 0.15–0.81). IFI was an independent predictor of all-cause mortality (aOR 6.33, 95% CI 2.46–17.83) in multivariable analysis. In the adjusted time-dependent Cox model, IFI remained independently associated with lower survival (aHR, 9.53; 95% CI, 5.79–15.68). Conclusions IFI is common and confers substantial mortality in patients with T/NKCL, with distinct pathogen-specific timing. These findings support early risk stratification and targeted preventive strategies in this high-risk population.