New York University Langone Medical Center, Memorial Sloan Kettering Cancer Center, New York, USA.
Clin Infect Dis. 2011 Oct;53(8):798-806. doi: 10.1093/cid/cir492. Epub 2011 Sep 2.
Infections are common in patients with hematologic neoplasms and following allogeneic hematopoietic transplantation. Neutropenia and defects in adaptive B-cell-mediated immunity and/or lack of splenic function predispose patients to a host of diverse and often serious infections. It is important to recognize that patients who undergo treatment for hematologic neoplasms may have mixed immune defects, and their vulnerability to infection may continue to change, in part as a reflection of the dynamic developments in the practice of oncology. The main obstacle in providing targeted, evidence-based antimicrobial treatment is the unpredictable results of even the new generation of diagnostic assays. A definite diagnosis for most end-organ opportunistic diseases requires tissue samples that are seldom available. Because immune defects may coexist, empirical therapy is directed toward a wide spectrum of pathogens. Real-time information about innate and adaptive immune functions and the role of acute and chronic phase molecules may improve target-specific therapy.
感染在血液系统恶性肿瘤患者和异基因造血移植后很常见。中性粒细胞减少症和适应性 B 细胞介导的免疫缺陷和/或脾脏功能缺失使患者易患多种且往往严重的感染。重要的是要认识到，接受血液系统恶性肿瘤治疗的患者可能存在混合免疫缺陷，其感染易感性可能会继续发生变化，部分原因是肿瘤学实践中的动态发展。提供靶向、基于证据的抗菌治疗的主要障碍是即使是新一代诊断检测的结果也具有不可预测性。大多数终末器官机会性疾病的确切诊断需要很少获得的组织样本。由于免疫缺陷可能同时存在，经验性治疗针对广泛的病原体。有关先天和适应性免疫功能以及急性和慢性阶段分子作用的实时信息可能会改善靶向特异性治疗。
