Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Dec 4;2020(1):135-139.
doi: 10.1182/hematology.2020000098.

Updates in infection risk and management in acute leukemia

C Logan  1 , D Koura  2 , R Taplitz  3
Affiliations
Review

Updates in infection risk and management in acute leukemia

C Logan et al. Hematology Am Soc Hematol Educ Program. .

Abstract

Patients with hematologic malignancies are at increased risk of infection, with associated morbidity and mortality. Patients with acute myeloid leukemia (AML) have qualitative and quantitative deficits in granulocytes predisposing to bacterial and fungal infections. Acute lymphoblastic leukemia results in qualitative deficits in lymphocytes, resulting in hypogammaglobulinemia and reduced cell-mediated immunity predisposing to certain bacterial and viral as well as fungal infections. Chemotherapeutic regimens often compound these deficits, result in prolonged periods of severe neutropenia, and disrupt mucosal barriers, further elevating infection risk. Despite advances in antimicrobial therapies and prophylaxis, acute leukemia patients with disease- and treatment-related immunosuppression remain at risk for life-threatening infection, including with resistant organisms, antimicrobial-related adverse events, and higher treatment costs. Additionally, our knowledge of infection risk and drug-drug interactions with new immune-targeted cancer therapeutics is evolving. Here, we review 3 areas in which standard practice is evolving as challenges arise and new experience is gained, including antibiotic use in febrile neutropenia, fungal prophylaxis, and use of targeted therapies.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: R.T. serves on a Merck advisory board. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
See this image and copyright information in PMC

References

    1. Nesher L, Rolston KV. The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection. 2014;42(1):5-13. - PubMed
    1. Zimmer AJ, Freifeld AG. Optimal management of neutropenic fever in patients with cancer. J Oncol Pract. 2019;15(1):19-24. - PubMed
    1. Averbuch D, Orasch C, Cordonnier C, et al. ; ECIL4, a joint venture of EBMT, EORTC, ICHS, ESGICH/ESCMID and ELN. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica. 2013;98(12):1826-1835. - PMC - PubMed
    1. Freifeld AG, Bow EJ, Sepkowitz KA, et al. ; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-e93. - PubMed
    1. Baden LR, Swaminathan S, Almyroudis NG, et al. . National Comprehensive Cancer Network. Prevention and Treatment of Cancer-Related Infections (Version 2.2020). Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf.

MeSH terms

Substances