Infections in patients with chronic lymphocytic leukaemia: Mitigating risk in the era of targeted therapies |
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Authors: | Benjamin W. Teh Constantine S. Tam Sasanka Handunnetti Leon J. Worth Monica A. Slavin |
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Affiliation: | 1. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia;2. National Centre for Infections in Cancer, Victoria, Australia;3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia;4. Department of Haematology, Peter MacCallum Cancer Centre, Victoria, Australia;5. Department of Haematology, St Vincent''s Hospital, Victoria, Australia;6. Department of Medicine, University of Melbourne, Victoria, Australia |
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Abstract: | Chronic lymphocytic leukaemia (CLL) is the most common leukaemia with infections a leading cause of morbidity and mortality. Recently there has been a paradigm shift from the use of chemo-immunotherapies to agents targeting specific B-lymphocyte pathways. These agents include ibrutinib, idelalisib and venetoclax. In this review, the risks and timing of infections associated with these agents are described, taking into account disease and treatment status. Treatment with ibrutinib as monotherapy or in combination with chemo-immunotherapies is not associated with additional risk for infection. In contrast, the use of idelalisib is associated with a 2-fold risk for severe infection and opportunistic infections. Venetoclax does not appear to be associated with additional infection risk. The evolving spectrum of pathogens responsible infections in CLL patients, especially those with relapsed and refractory disease are described, and prevention strategies (prophylaxis, monitoring and vaccination) are proposed. |
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Keywords: | Infection Chronic lymphocytic leukaemia Ibrutinib Idelalisib Venetoclax |
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