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Prevention of infections in patients with chronic lymphocytic leukemia

Author
Vicki Morrison, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Infections have a major impact on the clinical course of patients with chronic lymphocytic leukemia (CLL). Patients with CLL have underlying abnormalities in immune function related to the primary disease process in addition to defects in immune function related to the specific antileukemic therapies administered. The spectrum of infections in CLL patients has expanded with the use of therapies such as the purine analogs and monoclonal antibodies (eg, alemtuzumab).

The approach to infection prevention will be reviewed here. The immune defects related to CLL and its therapy as well as the spectrum of infectious complications are discussed separately. (See "Risk of infections in patients with chronic lymphocytic leukemia".)

The management and complications of CLL are discussed separately. (See "Overview of the treatment of chronic lymphocytic leukemia" and "Selection of initial therapy for symptomatic or advanced chronic lymphocytic leukemia" and "Treatment of relapsed or refractory chronic lymphocytic leukemia" and "Overview of the complications of chronic lymphocytic leukemia".)

ANTIMICROBIAL PROPHYLAXIS

General approach — There have been no randomized trials evaluating the use of prophylactic antimicrobials in patients with chronic lymphocytic leukemia (CLL), and there are no evidence-based guidelines for antimicrobial prophylaxis in this population. Most recommendations for antimicrobial prophylaxis have been extrapolated from prophylactic regimens used in treatment trials as well as from anecdotal reports. Since the immune defects caused by specific CLL therapies have significant impact on subsequent infectious complications, our prophylaxis recommendations vary depending upon the type of therapy used (table 1). Additional considerations that impact antimicrobial prophylaxis in individual patients are treatment status (treatment naïve versus heavily pretreated) and past history of infections. There are no unique prophylaxis recommendations for older adults versus younger patients [1].

Suggested prophylactic regimens (for those with an indication) are summarized in the following Table (table 2).

                 

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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 30 00:00:00 GMT+00:00 2016.
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