Arzoun Hadia, Srinivasan Mirra, Sandoval Stephanie, Lee Bridget
Internal Medicine, St. Bernard's Medical Center, Jonesboro, USA.
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2022 Mar 7;14(3):e22927. doi: 10.7759/cureus.22927. eCollection 2022 Mar.
Chronic lymphocytic leukemia (CLL) is one of the most commonly occurring types of leukemia among the elderly population, contributing to an increased vulnerability to infections that are especially prolific in the immunosuppressed and the risk of rapid progression of the disease into a more aggressive manifestation of large cell lymphoma, a process called Richter's Transformation (RT). CLL alone predisposes patients to develop infections; however, the additional complication of RT decreases survival and makes the prevention and control of infection for the CLL patient even more challenging. However, research that exists on preventing and controlling infection in CLL patients with RT is relatively limited. In most cases, studies have focused on the prevention of infection in CLL patients in general and with no reference to the progression of RT. Considering the dearth of research on infection prevention and control for patients with CLL complicated by RT specifically, the following review examines existing research in addressing the prevention and control of infection in CLL patients with RT and patients in general. The authors explored multiple databases such as PubMed, Google Scholar, and Science Direct. The ultimate focus of this study was to lay a fundamental understanding in preventing and controlling infection in CLL patients. After analyzing several studies, it can be concluded that identifying infections, even if rare, is a crucial aspect of managing CLL patients. A broad range of differential diagnoses should be sought in cases presenting with refractory CLL as well and management of infections before, during, or after CLL treatment should be considered.
慢性淋巴细胞白血病（CLL）是老年人群中最常见的白血病类型之一，这使得患者更易受到感染，尤其是在免疫抑制患者中感染更为频发，同时还存在疾病迅速进展为更具侵袭性的大细胞淋巴瘤的风险，这一过程称为里氏转化（RT）。仅CLL就使患者易发生感染；然而，RT这一额外并发症会降低生存率，使得CLL患者的感染预防和控制更具挑战性。然而，关于预防和控制合并RT的CLL患者感染的研究相对有限。在大多数情况下，研究集中在一般CLL患者的感染预防，而未涉及RT的进展情况。鉴于专门针对合并RT的CLL患者感染预防和控制的研究匮乏，以下综述审视了关于合并RT的CLL患者以及一般CLL患者感染预防和控制的现有研究。作者检索了多个数据库，如PubMed、谷歌学术和科学Direct。本研究的最终重点是对CLL患者感染的预防和控制形成基本认识。分析多项研究后可以得出结论，识别感染，即使是罕见感染，也是管理CLL患者的关键环节。对于难治性CLL病例，也应进行广泛的鉴别诊断，并应考虑在CLL治疗前、治疗期间或治疗后对感染进行管理。
