Authors: A.A. Tomescu, A. Enache, R. Dragan, M. Vasilica, D. Coriu, I. Ursuleac
Published: 2019-06-17
DOI: 10.1097/01.hs9.0000566648.02277.7d
Source: Full article
Background:During the last years, the overall response to the treatment of patients with chronic lymphocytic leukemia (CLL) has improved due to the introduction in the therapeutical armentarium of the new molecules ‐ Bruton kinase (BTK) inhibitors (Ibrutinib) and Phosphoinositide 3‐kinases (PI3Ks) inhibitors ‐ Idelalisib. The main late adverse reaction of the treatment with these 2 products is immunosupression with high infectious risk, including viral reactivations and opportunistic de novo infections (bacterial, mycotic or viral).Aims:To find the risk factors associated to the risk of infections in CLL patients treated with new moleculesMethods:A retrospective, clinico‐epidemiological study including 12 CLL patients diagnosed in our centre with various infections during therapy with Idelalisib or Ibrutinib.Results:12 CLL patients (6 men, 6 women) have been observed: 2 treated with Idelalisib 150 mg BID and 10 treated with Ibrutinib 420 mg QD; median age ‐ 56 years (35 – 75). There have been studied: the number of anterior therapeutic lines (2 – 5 patients, 3 – 5 patients, 4 – 2 patients), treatment‐free period before new molecules have been introduced (medium 15 months), therapy duration before the onset of the infection (19 months medium); additional risk factors ‐ previous hypogammaglobulinemia (observed in all the studied patients). We have identified viral reactivations (CMV, VZV, HSV), fungal (Aspergillus sp.) and bacterial (Klebsiella sp., E. coli, Corynebacterium bovis, MRSA) infections. The localizations were: cerebral (2 cases of aspergillosis and CMV), pulmonary (3 cases of aspergillosis), genito‐urinary (3 cases of multiresistent E. coli and HSV) and cutaneous (2 cases of HSV and MRSA). 5 deaths occurred due to uncontrolled disease and infection.Summary/Conclusion:Treatment with new molecules is associated with high infectious risk. We have identified multiple causes: advanced stage of disease, heavily treated patiens, hypogammaglobulinemia and comorbidities (diabetes). These patients should be closely monitored for infectious risk during treatment with new molecules.