Management of immunosuppression in the treatment of chronic lymphocytic leukemia
In patients with chronic lymphocytic leukemia (CLL), infections exert a substantial influence on morbidity and mortality. Hypogammaglobulinemia is one important predisposing factor for development of infections. The use of purine analogs, such as fludarabine, and monoclonal antibodies, such as rituximab and alemtuzumab, has introduced a new spectrum of infectious complications caused by pathogens such as Pneumocystis jiroveci, mycobacteria, listeria, and herpes viruses, as well as of fungal infections; these infections are mainly related to cellular immunosuppression induced by these agents. This short review focusses on risk factors, the causative spectrum of infectious complications, and possible preventive approaches in CLL patients, including antimicrobial, immunoglobulin prophylaxis, and vaccination strategies.