News in the Supportive Care of Chronic Lymphocytic Leukemia

Czech version

Authors: M. Brejcha
Authors‘ workplace: Hematologické oddělení, Nemocnice Nový Jičín a. s.
Published in: Klin Onkol 2015; 28(Supplementum 3): 50-54
doi: https://doi.org/10.14735/amko20153S50

Overview

Patients with chronic lymphocytic leukemia have disrupted cellular and humoral immunity with quantitative and qualitative impairment of the cells of the immune system. Immunity disbalance leads to increased incidence of infections and autoimmune cytopenias. Supportive care for chronic lymphocytic leukemia focuses on prevention and treatment of these complications and consists of antimicrobial prophylaxis, substitution of immunoglobulins, immunosuppressive therapy, growth factors and blood transfusions.

Key words:
chronic lymphocytic leukemia – supportive care – infectious complications

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted:
15. 7. 2015

Accepted:
2. 8. 2015

Sources

1. Dearden C. Disease‑ specific complications of chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program 2008; 2008(1): 450– 456. doi: 10.1182/ asheducation‑ 2008.1.450.

2. Hamblin AD, Hamblin TJ. The immunodeficiency of chronic lymphocytic leukaemia. Br Med Bull 2008; 87(1): 49– 62. doi: 10.1093/ bmb/ ldn034.

3. Diehl LF, Ketchum LH. Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia. Semin Oncol 1998; 25(1): 80– 97.

4. Buggins AG, Patten PE, Richards J et al. Tumor‑ derived IL‑6 may contribute to the immunological defect in CLL. Leukemia 2008; 22(5): 1084– 1087.

5. Kay NE, Zarling JM. Impaired natural killer activity in patients with chronic lymphocytic leukemia is associated with a deficiency of azurophilic cytoplasmic granules in putative NK cells. Blood 1984; 63(2): 305– 309.

6. Itälä M, Vainio O, Remes K. Functional abnormalities in granulocytes predict susceptibility to bacterial infections in chronic lymphocytic leukaemia. Eur J Haematol 1996; 57(1): 46– 53.

7. Schlesinger M, Broman I, Lugassy G. The complement system is defective in chronic lymphatic leukemia patients and in their healthy relatives. Leukemia 1996; 10(9): 1509– 1513.

8. Wadhwa PD, Morrison VA. Infectious complications of chronic lymphocytic leukemia. Semin Oncol 2006; 33(2): 240– 249.

9. Morrison VA. Management of infectious complications in patients with chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program 2007; 2007(1): 332– 338.

10. Melchardt T, Weiss L, Greil R et al. Viral infections and their management in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2013; 54(8): 1602– 1613. doi: 10.3109/ 10428194.2012.755178.

11. Anaissie EJ, Kontoyiannis DP, O’Brien S et al. Infections in patients with chronic lymphocytic leukemia treated with fludarabine. Ann Intern Med 1998; 129(7): 559– 566.

12. Cheson BD. Infectious and immunosuppressive complications of purine analog therapy. J Clin Oncol 1995; 13(9): 2431– 2448.

13. Byrd JC, McGrail LH, Hospenthal DR et al. Herpes virus infections occur frequently following treatment with fludarabine: results of a prospective natural history study. Br J Haematol 1999; 105(2): 445– 447.

14. Frank DA, Mahajan S, Ritz J. Fludarabine‑induced immunosuppression is associated with inhibition of STAT1 signaling. Nat Med 1999; 5(4): 444– 447.

15. Gurion R, Raanani P, Shpilberg O et al. bendamustine is not associated with an increase in infections – systematic review and meta‑analysis of randomized controlled trials. Blood 2013; 122(21): 5125– 5125.

16. Smolej L, Doubek M, Panovská A et al. Rituximab in combination with high‑dose dexamethasone for the treatment of relapsed/ refractory chronic lymphocyticleukemia. Leuk Res 2012; 36(10): 1278– 1282. doi: 10.1016/ j.leukres.2012.07.005.

17. Dervite I, Hober D, Morel P. Acute hepatitis B in a patient with antibodies to hepatitis B surface antigen who was receiving rituximab. N Engl J Med 2001; 344(1): 68– 69.

18. Martin SI, Marty FM, Fiumara K et al. Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis 2006; 43(1):16– 24.

19. Brown JR, Byrd JC, Coutre SE et al. Idelalisib, an inhibitor of phosphatidylinositol 3- kinase p110δ, for relapsed/ refractory chronic lymphocytic leukemia. Blood 2014; 123(22): 3390– 3397. doi: 10.1182/ blood‑ 2013‑ 11‑ 535047.

20. Byrd JC, Furman RR, Coutre SE et al. Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. N Engl J Med 2013; 369(1): 32– 42. doi: 10.1056/ NEJMoa1215637.

21. Oscier D, Dearden C, Erem E et al. Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia. Br J Haematol 2012; 159(5): 541– 564. doi: 10.1111/ bjh.12067.

22. Donath E, Chaudhry A, Hernandez‑ Aya LF et al. A meta‑analysis on the prophylactic use of macrolide antibiotics for the prevention of disease exacerbations in patients with chronic obstructive pulmonary disease. Respir Med 2013; 107(9): 1385– 1392. doi: 10.1016/ j.rmed.2013.05.004.

23. Segal BH, Freifeld AG, Baden LR et al. Prevention and treatment of cancer‑related infections. J Natl Compr Canc Netw 2008; 6(2): 122– 174.

24. Radocha J, Zavřelová A, Žák P. Profylaxe pneumocystové pneumonie u hematologických nemocných. Postgraduální medicína 2013; 15 (Suppl): 35– 37.

25. Osterborg A, Foà R, Bezares RF et al. Management guidelines for the use of alemtuzumab in chronic lymphocytic leukemia. Leukemia 2009; 23(11): 1980– 1988. doi: 10.1038/ leu.2009.146.

26. O’Brien SM, Keating MJ, Mocarski ES. Updated guidelines on the management of cytomegalovirus reactivation in patients with chronic lymphocytic leukemia treated with alemtuzumab. Clin Lymphoma Myeloma 2006; 7(2): 125– 130.

27. Artz AS, Somerfield MR, Feld JJ et al. American Society of Clinical Oncology provisional clinical opinion: chronic hepatitis B virus infection screening in patients receiving cytotoxic chemotherapy for treatment of malignant diseases. J Clin Oncol 2010; 28(19): 3199– 3202. doi: 10.1200/ JCO.2010.30.0673.

28. Molica S, Levato D, Levato L. Infections in chronic lymphocytic leukemia. Analysis of incidence as a function of length of follow‑up. Haematologica 1993; 78(6): 374– 377.

29. Itälä M, Helenius H, Nikoskelainen J et al. Infections and serum IgG levels in patients with chronic lymphocytic leukemia. Eur J Haematol 1992; 48(5): 266– 270.

30. Sampalo A, Brieva JA. Humoral immunodeficiency in chronic lymphocytic leukemia: role of CD95/ CD95L in tumoral damage and escape. Leuk Lymphoma 2002; 43(4): 881– 884.

31. Raanani P, Gafter‑ Gvili A, Paul M et al. Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation. Leuk Lymphoma 2009; 50(5): 764– 772. doi: 10.1080/ 10428190902856824.

32. Zelenetz AD, Abramson JS, Advani R et al. Non‑ Hodgkin’s Lymphomas. J Natl Compr Canc Netw 2010; 8(3): 288– 334.

33. Compagno N, Cinetto F, Semenzato G et al. Subcutaneous immunoglobulin in lymphoproliferative disorders and rituximab‑related secondary hypogammaglobulinemia: a single‑center experience in 61 patients. Haematologica 2014; 99(6): 1101– 1106. doi: 10.3324/ haematol.2013.101261.

34. Hartkamp A, Mulder AH, Rijkers GT et al. Antibody responses to pneumococcal and haemophilus vaccinations in patients with B‑ cell chronic lymphocytic leukaemia. Vaccine 2001; 19(13): 1671– 1677.

35. Sinisalo M, Aittoniemi J, Oivanen P et al. Response to vaccination against different types of antigens in patients with chronic lymphocytic leukaemia. Br J Haematol 2001; 114(1): 107– 110.

36. Sinisalo M, Vilpo J, Itälä M et al. Antibody response to 7- valent conjugated pneumococcal vaccine in patients with chronic lymphocytic leukaemia. Vaccine 2007; 26(1): 82– 87.

37. De Lavallade H, Garland P, Sekine T et al. Repeatedvaccination is required to optimize seroprotection against H1N1 in the immunocompromised host. Haematologica 2011; 96(2): 307– 314. doi: 10.3324/ haematol.2010.032664.

38. Kim DK, Bridges CB, Harriman KH et al, Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older – United States, 2015. Ann Intern Med 2015; 162(3): 214– 223.

39. Barcellini W, Capalbo S, Agostinelli RM et al. Relationship between autoimmune phenomena and disease stage and therapy in B‑ cell chronic lymphocytic leukemia. Haematologica 2006; 91(12): 1689– 1692.

40. Dearden C, Wade R, Else M et al. The prognostic significance of a positive direct antiglobulin test in chronic lymphocytic leukemia: a beneficial effect of the combination of fludarabine and cyclophosphamide on the incidence of hemolytic anemia. Blood 2008; 111(4): 1820– 1826.

41. Visco C, Ruggeri M, Laura EM et al. Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia. Blood 2008; 111(3): 1110– 1116.

42. Cortes J, O’Brien S, Loscertales J et al. Cyclosporin A for the treatment of cytopenia associated with chronic lymphocytic leukemia. Cancer 2001; 92(8): 2016– 2022.

43. Hill J, Walsh RM, McHam S et al. Laparoscopic splenectomy for autoimmune hemolytic anemia in patients with chronic lymphocytic leukemia: a case series and review of the literature. Am J Hematol 2004; 75(3): 134– 138.

44. Guiney MJ, Liew KH, Quong GG et al. A study of splenic irradiation in chronic lymphocytic leukemia. Int J Radiat Oncol Biol Phys 1989; 16(1): 225– 229.

45. D’Arena G, Laurenti L, Capalbo S et al. Rituximab therapy for chronic lymphocytic leukemia‑associated autoimmune hemolytic anemia. Am J Hematol 2006; 81(8): 598– 602.

46. Karlsson C, Hansson L, Celsing F et al. Treatment of severe refractory autoimmune hemolytic anemia in B‑ cell chronic lymphocytic leukemia with alemtuzumab (humanized CD52 monoclonal antibody). Leukemia 2007; 21(3): 511– 514.

47. Koehrer S, Keating MJ, Wierda W. Eltrombopag, a second‑ generation thrombopoietin receptor agonist, for chronic lymphocytic leukemia‑associated ITP. Leukemia 2010; 24(5): 1096– 1098. doi: 10.1038/ leu.2010.45.

48. Sinisalo M, Sankelo M, Itälä‑ Remes M. Thrombopoietin receptor agonists can be used temporarily with patients suffering from refractory chronic lymphocytic leukemia‑associated immunologic thrombocytopenia. Leuk Lymphoma 2011; 52(4): 724– 725. doi: 10.3109/ 10428194.2010.551794.

49. Kaufman M, Limaye SA, Driscoll N et al. A combination of rituximab, cyclophosphamide and dexamethasone effectively treats immune cytopenias of chronic lymphocytic leukemia. Leuk Lymphoma 2009; 50(6): 892– 899. doi: 10.1080/ 10428190902887563.

50. Siakantaris MP, Angelopoulou MK, Vassilakopoulos TP et al. Correction of disease related anaemia of B‑ chronic lymphoproliferative disorders by recombinant human erythropoietin: maintenance is necessary to sustain response. Leuk Lymphoma 2000; 40(1– 2): 141– 147.

51. Maung ZT, Wood AC, Jackson GH et al. Transfusion‑associated graft‑ versus‑ host disease in fludarabine‑treated B‑ chronic lymphocytic leukaemia. Br J Haematol 1994; 88(3): 649– 652.

52. Treleaven J, Gennery A, Marsh J et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Br J Haematol 2011; 152(1): 35– 51. doi: 10.1111/ j.1365‑ 2141.2010.08444.x.

53. Itälä M, Pelliniemi TT, Remes K et al Long‑term treatment with GM‑CSF in patients with chronic lymphocytic leukemia and recurrent neutropenic infections. Leuk Lymphoma 1998; 32(1– 2): 165– 174.

54. Lyman GH. Guidelines of the National Comprehensive Cancer Network on the use of myeloid growth factors with cancer chemotherapy: a review of the evidence. J Natl Compr Cancer Netw 2005; 3(4): 557– 571.

55. Byrd JC, Peterson BL, Morrison VA et al. Randomized phase 2 study of fludarabine with concurrent versus sequential treatment with rituximab in symptomatic, untreated patients with B‑ cell chronic lymphocytic leukemia: results from Cancer and Leukemia Group B 9712 (CALGB 9712). Blood 2003; 101(1): 6– 14.