Prophylactic strategies to meet infectious complications in fludarabine-treated CLL.
Sudhoff T, Arning M, Schneider W.
Leukemia. 1997 Apr;11 Suppl 2:S38-41
Department of Hematology and Oncology, Heinrich-Heine-University, Dusseldorf, Germany.
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.
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