12Infectious complications of chronic lymphocytic leukaemia: pathogenesis, spectrum of infection, preventive approaches
Section snippets
Pathogenesis of infection in patients with chronic lymphocytic leukaemia
Patients with CLL are at risk for infection for a variety of aetiologies. These patients have inherent immune defects in humoral, as well as cell-mediated, immunity, which are related to the primary disease process. These defects include hypogammaglobulinaemia, abnormalities in T-cell subsets and defects in complement activity and neutrophil/monocyte function [1], [2]. In addition, specific immunodeficiencies related to therapies rendered to these patients result in additional immunosuppression.
Spectrum of infectious complications in patients with CLL
There has been an evolution in the spectrum of infections that are more commonplace in patients with CLL. For the most part, this has been related to the introduction of newer therapies that have their own unique impact on immune function, as the purine analogues and monoclonal antibodies. We discuss this spectrum as follows by type of therapy administered.
Antimicrobial prophylaxis
There are no standard guidelines for antimicrobial prophylaxis in CLL patients, and in general, most recommendations for these agents are derived from clinical trials and anecdotal reports. Herpesvirus infections, most of which were localised grade 1/2 infections, have been found to be more common in patients receiving single agent fludarabine, as compared to chlorambucil in a retrospective review [12]. Some advocate the use of antiviral prophylaxis in CLL patients with a low CD4 count and in
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