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Alert Number 192

Infections: Who Is Most at Risk?

Date: September 2, 2006

Once every couple of days I hear from patients who are having a hard time convincing their local oncologists to take their risk of infection seriously. Here is a bit more ammunition for you to use, in your “negotiations” with your reluctant healthcare provider.

This latest paper in Cancer, the journal of the American Cancer Society, reaffirms what we have been preaching all along:

  • 30%-50% of CLL patients die of infections, secondary effect of their compromised immune system.
  • In this reasonably large cohort, older age, late stage CLL, unmutated IgVH phenotype and CD38 positivity were high risk factors of getting infections and dying from them.
  • The type of initial therapy chosen was also a significant risk factor. In other words, taking on more immune suppression right up front in order to control the CLL may have collateral damage you may not thought about.
  • Last but not least, this paper suggests it is a good idea to be a bit more aggressive in protecting these high risk CLL patients with intravenous immunoglobulins (IVIG) and pre-emptive antibiotics.

If you want to read the full text article of the Cancer 2006 article cited below, write to us.

For those of you who have been diligent in doing your reading of our review articles, none of this should come as a surprise. Just in case you have taken the summer off, here are some links to articles you should look up. What you (and your oncologist) don’t know can indeed kill you and death by outdated conventional wisdom will still put you six feet under. If you have not gotten around to getting your prognostic package done, perhaps you should get a move on and procrastinate no further. Head-in-sand is not a good management option in CLL. If you are a new comer to the CLL scene, our CLL Primer is a good place to start, it has many of the links to must-read reviews on our website.

Infections: Who is Most at Risk?;
Infectious Complications;
IVIG Benefits;
EBV: The Enemy Within;
Drug Resistant Staph: A Very Dangerous Super-Bug;
Winning The Battle But Losing The War;
What You And Your Oncologist Need To Know.

Be well,



Cancer. 2006 Sep 1;107(5):1023-33.

The effect of immunoglobulin V(H) gene mutation status and other prognostic factors on the incidence of major infections in patients with chronic lymphocytic leukemia.

Francis S, Karanth M, Pratt G, Starczynski J, Hooper L, Fegan C, Pepper C, Valcarcel D, Milligan DW, Delgado J.

Department of Hematology, Birmingham Heartlands Hospital, Birmingham, United Kingdom.

BACKGROUND: Infections are a major factor in the clinical course of chronic lymphocytic leukemia (CLL) and account for 30% to 50% of all deaths. The pathogenesis of infections in CLL is related to hypo-gamma-globulinemia, T-cell immune dysfunction, and the immunosuppressive effect of treatment.
METHODS: The authors retrospectively assessed the correlations between new prognostic markers and types of infections encountered, the time taken to develop these infections, and infection-related mortality in 280 unselected patients with CLL.
RESULTS: One hundred patients (36%) had at least 1 major infection (median, 2 major infections; range, 1-8 major infections) over a median follow-up of 67 months. Infections were the most common cause of death, accounting for 51% of all fatalities. Older age (P = .007), clinical Stage B or C disease (P < .001), unmutated immunoglobulin (Ig)V(H) gene status (P < .001), genetic abnormalities (P < .001), positive CD38 status (P < .001), and type of initial therapy were associated with a significantly shorter time to first infection. Equally, patient age (P < .001), disease stage (P < .001), CD38 expression (P < .001), IgV(H) mutation status (P < .001), and genetic abnormalities (P = .003) had a significant impact on infection-related mortality.
CONCLUSIONS: Clinical stage at diagnosis, IgV(H) mutation status, and initial therapy were possible predictors of severe infections in patients with CLL. The current results may help to identify which patients with CLL are at particularly high risk of developing serious infections and, thus, should be considered for Ig or antibiotic prophylaxis.

Cancer 2006. (c) 2006 American Cancer Society.

PMID: 16862572

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