SOHO 2021: Can the Natural History of Immune Dysfunction and Infections in CLL Be Altered?
Posted: Monday, September 13, 2021
Immune dysfunction and infections represent the hallmark of chronic lymphocytic leukemia (CLL) and remain the major cause of death for patients with this hematologic malignancy. In an attempt to improve the natural history of immune dysfunction in CLL, Carsten Utoft Niemann, MD, PhD, of the Rigshospitalet and Copenhagen University, Denmark, and colleagues are assessing their CLL–treatment infection model (CLL-TIM) algorithm in identifying patients with CLL who might benefit from short-term treatment with the Bruton’s tyrosine kinase inhibitor acalabrutinib and the BCL2 inhibitor venetoclax in the PreVent-ACaLL trial (ClinicalTrials.gov identifier NCT03868722). In an extended abstract presented during the 2021 Society of Hematologic Oncology (SOHO) Annual Meeting (EXABS-192-CLL), Dr. Niemann also briefly discussed the management of infections in this patient population and what he hopes to achieve through this clinical trial.
“Employing the CLL-TIM algorithm, patients with a high (> 65%) risk of infection and/or need of CLL treatment within 2 years of diagnosis are currently enrolled for the phase II, randomized, investigator-initiated clinical trial PreVent-ACaLL,” Dr. Niemann explained.
Decisions regarding the use of supportive care for managing infections in patients with CLL—including antibiotics, vaccinations, or immunoglobulin substitution—should be guided by the microbial landscape at different stages of disease, according to Dr. Niemann. Although prophylactic antibiotics are not routinely recommended for patients with CLL, early empirical antibiotic therapy should be started if signs of clinical infection are seen in this patient population, he encouraged. As for the use of immunoglobulin substitution, Dr. Niemann considers it only for those with repeated severe infections and severe hypogammaglobulinemia.
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