How I manage infection risk and prevention in patients with lymphoid cancer

Abstract

Infections are a common cause of morbidity and mortality in patients with lymphoid cancer. With evolving cancer therapeutics, including new targeted and immunotherapies, clinicians need to be aware of additional risk factors and infections that may arise in patients treated with these agents. This "How I Treat" article will highlight fundamental issues including risk factors for infection, infectious diseases screenings and antimicrobial prophylaxis recommendations in patients with lymphoid cancers. We present 4 scenarios of patients with lymphoid cancers with varied infections and describe a treatment approach based on a combination of evidence-based data and experience, as there are limitations in objective infection data especially with newer agents. The goal of this discussion is to provide a framework for institutions and health care providers to develop their own approach in preventing and treating infections in patients with lymphoid cancer.

B-cell malignancies treated with targeted drugs and SARS-CoV-2 infection: A European Hematology Association Survey (EPICOVIDEHA)

“…Lymphoproliferative diseases (LPD) are a group of malignancy associated with a marked immunodeficiency, characterized by hypogammaglobulinemia, qualitative and quantitative B-and T-cell defects (5), CD4+ lymphopenia, as well as innate immune dysfunction and neutropenia (6). These immunodeficiencies are a result of the disease itself and its treatment, and lead to impaired immune response to common pathogens and poor response to vaccination (7,8) The introduction of targeted agents in the treatment of B-cell malignancies has changed their management.…”

Molnupiravir Compared to Nirmatrelvir/Ritonavir for COVID-19 in High-Risk Patients with Haematological Malignancy in Europe. A Matched-Paired Analysis from the Epicovideha Registry

“…These include, among others, patients with haematological malignancies, who are at a high-risk for severe forms of COVID-19, as they have an impaired immune system and the anti-SARS-CoV-2 vaccines may not reliably trigger an adequate immune response, as compared to healthy individuals. [10][11][12] Until January 2023, three antivirals have been developed: molnupiravir, 7 nirmatrelvir/ritonavir, 8 and remdesivir. 9 The first two are for oral administration, whereas the last is for intravenous injection, with the associated limitations for ambulatory use.…”