Management of Infections in Patients with CLL

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 21; pp. S136 - S138
• Main Author: Niemann, Carsten Utoft
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021
• Subjects: antibiotics; chronic lymphocytic leukemia; CLL; immune dysfunction; immunoglobulins; preemptive treatment; immune dysfunction; CLL; preemptive treatment; chronic lymphocytic leukemia; immunoglobulins; antibiotics
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(21)01240-4

Although chronic lymphocytic leukemia (CLL) is a malignancy characterized by accumulation of tumor cells in the blood, bone marrow, lymph nodes, and secondary lymphoid tissue,1 the hallmark of the disease and the major cause of death for patients with CLL is actually immune dysfunction and infections.2 Despite improvement in treatment based on combination chemoimmunotherapy and targeted treatment with BTK inhibitors and BCL-2 inhibitors, leading to longer overall survival for patients with CLL, the mortality due to infections has not improved over the last four decades.2 Thus, infections are now the main cause of death for patients with CLL, posing threats to the patient whether during the premalignant state of monoclonal B lymphocytosis (MBL),3 during watch-and-wait for treatment-naïve patients,4 or upon treatment with chemoimmunotherapy or targeted treatment.5,6 To test whether the natural history of immune dysfunction and infections in CLL can be changed, we have developed the machine learning-based algorithm CLL-TIM.org to identify these patients.7 The CLL-TIM algorithm is currently being used for the selection of patients for the clinical trial PreVent-ACaLL (NCT03868722), testing whether short-term treatment with the BTK inhibitor acalabrutinib and the BCL-2 inhibitor venetoclax can improve immune function and decrease the risk of infections for this high-risk patient population.