Management of Infectious Complications in Patients with Chronic Lymphocytic Leukemia

Abstract

Infections remain a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). The pathogenesis of these complications is related to immune defects inherent to the primary disease as well as to therapy-related immunosuppression. The spectrum of infections seen has evolved with the therapeutic use of purine analogs, which induce specific cellular immune defects, as well as the monoclonal antibodies alemtuzumab and rituximab. Although bacterial infections are most common, fungal and herpesvirus infections are also seen with use of these agents. This overview will summarize the pathogenesis of infection in patients with CLL as well as the spectrum of infection and approaches to the prophylactic and therapeutic management of these complications.

Disease-Specific Complications of Chronic Lymphocytic Leukemia

“…20 The risk of infection increases over time, especially in heavily pretreated patients with active disease, and is usually the cause of death in advanced CLL.…”

“…Common organisms include S pneumonia, S aureus, H influenzae. 20 Recurrent infections are common and may lead over time to chronic sinusitis and bronchiectasis in susceptible individuals. Herpes virus reactivation is relatively common, with H zoster being most frequent.…”

Chronic Lymphocytic Leukemia: A Paradigm of Innate Immune Cross-Tolerance

“…Several studies indicated that .50% of patients with CLL suffer from pathogen colonization, causing the death of 70% of these patients (4)(5)(6)(7)(8)(9)(10). Other studies reported that 80% of patients with CLL suffer from infections (11).…”

Infections in Leukemia

“…Disseminated candidiasis and aspergillosis are well recognized offenders. Concurrent treatment with steroids increases the likelihood of pneumocystis infections (93). Viral infections are common, especially varicella zoster virus (VZV) infection, which may be complicated by a high incidence of post-herpetic neuralgia.…”