Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia; National Centre for Infections in Cancer, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.
Department of Haematology, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Haematology, St Vincent's Hospital, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia.
Blood Rev. 2018 Nov;32(6):499-507. doi: 10.1016/j.blre.2018.04.007. Epub 2018 Apr 23.
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia with infections a leading cause of morbidity and mortality. Recently there has been a paradigm shift from the use of chemo-immunotherapies to agents targeting specific B-lymphocyte pathways. These agents include ibrutinib, idelalisib and venetoclax. In this review, the risks and timing of infections associated with these agents are described, taking into account disease and treatment status. Treatment with ibrutinib as monotherapy or in combination with chemo-immunotherapies is not associated with additional risk for infection. In contrast, the use of idelalisib is associated with a 2-fold risk for severe infection and opportunistic infections. Venetoclax does not appear to be associated with additional infection risk. The evolving spectrum of pathogens responsible infections in CLL patients, especially those with relapsed and refractory disease are described, and prevention strategies (prophylaxis, monitoring and vaccination) are proposed.
慢性淋巴细胞白血病（CLL）是最常见的白血病，感染是导致发病率和死亡率的主要原因。最近，人们的治疗模式已经从化疗免疫疗法转变为针对特定 B 淋巴细胞途径的药物。这些药物包括伊布替尼、idelalisib 和 venetoclax。在这篇综述中，考虑到疾病和治疗状况，描述了与这些药物相关的感染风险和时机。伊布替尼单药或与化疗免疫疗法联合治疗不会增加感染的风险。相比之下，idelalisib 的使用与严重感染和机会性感染的风险增加 2 倍相关。venetoclax 似乎不会增加额外的感染风险。描述了 CLL 患者感染的病原体谱的演变，特别是那些复发和难治性疾病的患者，并提出了预防策略（预防、监测和疫苗接种）。
