Wadhwa Punit D, Morrison Vicki A
Section of Hematology/Oncology, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN 55417, USA.
Semin Oncol. 2006 Apr;33(2):240-9. doi: 10.1053/j.seminoncol.2005.12.013.
Infectious complications continue to be one of the major causes of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). The pathogenesis of infections in these patients is multifactorial. Hypogammaglobulinemia is an important predisposing factor for infection in patients with early-stage disease and for those treated with conventional alkylating agents. However, the proportion of patients treated with purine analogs and monoclonal antibodies such as rituximab and alemtuzumab is increasing. As a result of this therapy, these patients often experience profound and sustained T-cell immunodeficiency. Consequently, the spectrum of organisms causing infections in these patients is changing from common bacterial organisms to less common opportunistic pathogens such as Pneumocystis, Listeria, mycobacteria, herpesviruses, and Candida. This review focuses on the pathogenesis and risk factors for infections in patients with CLL, the spectrum of infectious organisms associated with the newer agents, and the management of these infections with an emphasis on prophylaxis and vaccination strategies.
感染性并发症仍然是慢性淋巴细胞白血病（CLL）患者发病和死亡的主要原因之一。这些患者感染的发病机制是多因素的。低丙种球蛋白血症是早期疾病患者以及接受传统烷化剂治疗患者发生感染的重要易感因素。然而，接受嘌呤类似物和利妥昔单抗、阿仑单抗等单克隆抗体治疗的患者比例正在增加。由于这种治疗，这些患者经常出现严重且持续的T细胞免疫缺陷。因此，这些患者中引起感染的微生物谱正在从常见的细菌病原体转变为不太常见的机会性病原体，如肺孢子菌、李斯特菌、分枝杆菌、疱疹病毒和念珠菌。本综述重点关注CLL患者感染的发病机制和危险因素、与新型药物相关的感染性微生物谱，以及这些感染的管理，重点是预防和疫苗接种策略。
