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. 2025 May;26(5):e242-e252.
doi: 10.1016/S1470-2045(25)00079-8.

Antimicrobial resistance in patients with haematological malignancies: a scoping review

Ya Haddy Sallah  1 , Vanessa F Bratti  2 , Bahar Rafinejad-Farahani  3 , Shalini Jayasekar Zurn  4 , Sonali Johnson  4 , André S Crestani  5 , Maria I Dacoregio  6 , Haris Majeed  7 , Rouhi Fazelzad  8 , Aliyah Pabani  9 , Brooke E Wilson  10 , Fernanda M Favorito  11 , Fabio Ynoe de Moraes  12 , Lillian Sung  13 , Yehoda M Martei  14 , Danielle Rodin  15
Affiliations

Antimicrobial resistance in patients with haematological malignancies: a scoping review

Ya Haddy Sallah et al. Lancet Oncol. 2025 May.

Abstract

Antimicrobial resistance (AMR) is a substantial global health threat. Patients with haematological malignancies have an increased risk of AMR infection due to disease-related and treatment-related immunosuppression. This scoping review searched four bibliographic databases from Jan 1, 2000, to Dec 7, 2023, for publications on AMR bacterial infections in patients with haematological malignancies and identified 274 eligible articles. AMR prevalence data extraction focused on WHO bacterial priority pathogens. The prevalence of AMR bacterial infections from seven WHO priority pathogens in patients with haematological malignancies was 35% (95% CI 30-40; I2 99·4%). The most frequent AMR infections reported were bloodstream infections, with the highest reported AMR pathogens in third-generation cephalosporin-resistant Enterobacterales (pooled prevalence rate 44% [95% CI 23-64; I2 99·8%]), meticillin-resistant Staphylococcus aureus (43% [31-54; I2 95·9%]), and vancomycin-resistant enterococci (41% [26-56; I2 96·2%]). 53 (65%) of the 81 studies that reported mortality showed higher mortality rates associated with AMR infections. 168 (61%) studies were conducted in high-income countries, with no studies published from the WHO Africa region, revealing a substantial data gap from low-income and middle-income regions. Future efforts should prioritise standardised reporting measures, robust surveillance, antimicrobial stewardship, and well designed clinical trials, particularly in under-represented regions, to mitigate the effect of AMR on cancer care.

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Conflict of interest statement

Declaration of interests This study was funded by the Global Cancer Program at Princess Margaret Cancer Centre (Toronto, ON, Canada). AP declares honoraria received for educational sessions from AstraZeneca, Roche, Pfizer, Regeneron; and a quality improvement grant from Bristol-Myers Squibb. BEW declares an institutional grant from Bristol-Meyers Squibb; consulting fees received from Gilead and Novartis; and honoraria received from AstraZeneca. DR is supported by the Hold ‘Em for Life Professorship in Cancer Research, a named professorship at the University of Toronto, and holds funding from the Canadian Cancer Society and the Leukemia and Lymphoma Society, outside of the submitted work. None of the authors are employed by the National Institutes of Health. All other authors declare no competing interests. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps.

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