Guidelines on the diagnosis and management of chronic lymphocytic leukaemia

The effect of immunoglobulin VH gene mutation status and other prognostic factors on the incidence of major infections in patients with chronic lymphocytic leukemia

“…7,10,23,25 Several predisposing factors have been suggested over the last 50 years, including hypo-g-globulinemia, neutropenia, defective T-cell function, and reduced complement activity. 7,26 In keeping with previous reports, the infective pattern observed in the current work was very similar to that observed in primary humoral immune deficiencies. 7,27,28 Encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae) were common pathogens in respiratory tract infections, whereas other streptococci and staphylococci were identified more frequently in episodes of septicemia.…”

“…Ig replacement therapy is recommended after the first or second major infective episode in patients with hypo-g-globulinemia. 26 This approach stems from a randomized trial in which regular Ig infusions reduced the incidence of bacterial infections in patients who had hypo-g-globulinemia and a history of infections. 37 We believe that Ig replacement therapy still is appropriate in these patients, 26 because they had an increased incidence of major infections, and this approach may reduce the number of hospital admissions.…”

“…26 This approach stems from a randomized trial in which regular Ig infusions reduced the incidence of bacterial infections in patients who had hypo-g-globulinemia and a history of infections. 37 We believe that Ig replacement therapy still is appropriate in these patients, 26 because they had an increased incidence of major infections, and this approach may reduce the number of hospital admissions. Furthermore, the infective pattern observed (frequent encapsulated organisms, fewer viral and fungal infections) also supports the use of regular Ig infusions.…”

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

“…Before initiating alemtuzumab treatment, baseline status should be evaluated through examination of overall physical characteristics; computed tomography (CT) or ultrasound scan of enlarged and potentially palpable lymph nodes, liver, or spleen (where indicated); assessment of comorbid disease; serological status of hepatitis B, hepatitis C, CMV, HSV, VZV, EBV, and HIV; and complete blood counts [45]. The strategy of infection monitoring and prophylaxis must always consider these baseline findings and other risk factors from the patient's medical history, such as age, comorbid diseases, and earlier infections.…”

Quantitative flow cytometry of ZAP‐70 levels in chronic lymphocytic leukemia using molecules of equivalent soluble fluorochrome

“…The diagnosis of CLL was based on standard morphologic and immunophenotype criteria, (CD19 þ , CD5 þ , and CD23 þ and weak sIg/ CD79b expression as the basis) and the simple scoring system suggested by Moreau et al (22) as outlined in the Guidelines on diagnosis and management of CLL in the British Journal of Hematology (23). The study was approved by the Institutional Ethics Committee according to the guidelines of the Helsinki accords, and blood samples were obtained with written informed consent.…”