Prophylactic strategies to meet infectious complications in fludarabine-treated CLL.
Fludarabine has emerged as salvage therapy in chlorambucil-resistant CLL. However, encouraging response rates have been compromised by a high incidence of serious infectious complications. Prophylactic measures to reduce the frequency of infections are needed, but up to now, there are no established standards for supportive therapy in fludarabine-treated CLL. Clinicians have observed an increasing frequency of life-threatening opportunistic infections but only some of these may be explained by fludarabine-induced impairment of cell-mediated immunity. Neutrocytopenia commonly found during initial fludarabine treatment may not have been addressed sufficiently as risk factor for infections. Thus, G-CSF supplementation may improve the rate of infectious complications by reducing the duration of fludarabine-induced neutrocytopenia. The changing spectrum of infectious complications should stimulate additional trials on the value of IVIG replacement in fludarabine-treated CLL patients and on the role of low-dose co-trimoxazole in patients at high risk of Pneumocystis carinii infections.
Südhoff
T
T
Department of Hematology and Oncology, Heinrich-Heine-University, Düsseldorf, Germany.
Arning
M
M
Schneider
W
W
D019072:Antibiotic Prophylaxis; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015994:Incidence; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control; D009894:Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D016879:Salvage Therapy; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives*
D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D016179:Granulocyte Colony-Stimulating Factor; D014740:Vidarabine; C024352:fludarabine