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Risk 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 immune defects related to the specific antileukemic therapies administered. The spectrum of infections in CLL patients has evolved with the introduction of therapies such as the purine analogs and monoclonal antibodies (eg, alemtuzumab).

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

The immune defects caused by the drugs and biologics used for CLL and other diseases is also reviewed separately. (See "Secondary immunodeficiency induced by biologic therapies".)

IMMUNE DEFECTS

Patients with chronic lymphocytic leukemia (CLL) have inherent immune defects in humoral and cell-mediated immunity that are related to the primary disease process, including hypogammaglobulinemia, abnormalities in T cell subsets, and defects in complement activity and neutrophil/monocyte function [1,2]. Therapy-related immunosuppression has further impact on immune function.

Humoral immunity — Hypogammaglobulinemia is the most predominant inherent immune defect in CLL patients, with subtypes IgG3 and IgG4 particularly affected. Hypogammaglobulinemia is related to defective functioning of T cells and non-clonal CD5-negative B cells. Hypogammaglobulinemia becomes more pronounced with longer disease duration and advanced stage disease. There is generally no reversal in this defect, even with response to therapy. Although an association between hypogammaglobulinemia and infection frequency and survival has been demonstrated, there is no consistent correlation between a specific immunoglobulin class deficiency and infection risk [1,3,4].

               

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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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