Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)

Abstract

Introduction: Patients with hematological and advanced solid malignancies have acquired immune dysfunction, often exacerbated by treatment, posing a significant risk for development of infections. These are often difficult to diagnose and poorly responsive to anti-infective therapy. This review evaluates the utility of current clinical and treatment guidelines, as well as recent and emerging innovative approaches and therapies, in the setting of management of infections in cancer patients.Areas Covered: These include causes of infection in cancer patients, management of patients with high-risk and low-risk febrile neutropenia, management of low-risk patients in an outpatient setting, the role of granulocyte colony-stimulating factor (G-CSF) in the prevention and treatment of neutropenia-related infections, management of lung infections in various clinical settings, and emerging challenges surrounding the risk of infection in cancer patients treated with novel treatments, including targeted therapies, and immunotherapies. The literature search was performed by accessing PubMed and other databases, focusing on published clinical trials of relevant anti-cancer agents and diseases. These primarily coveried the recent past, but also included several key studies published during the last decade and, somewhat earlier in a few cases.Expert Review: Notwithstanding the promise of gene therapy/gene editing in hematological malignancies and some types of solid cancers, innovations introduced in clinical practice include more discerning clinical management such as the generalized use of biosimilar formulations G-CSF and the implementation of novel, innovative immunotherapies.

Application Value of Metagenomics Next-Generation Sequencing (mNGS) in Detection of Mucormycosis after Chemotherapy in Childhood Acute Leukemia

“…Mucormycosis is a rare but extremely fatal invasive fungal disease. Several studies have shown that the underlying disease in patients is also related to the site of infection; pulmonary mucormycosis is more common in patients with hematologic malignancies and neutropenia, nasal orbital cerebral mucormycosis is more common in patients with diabetes, and trauma usually leads to cutaneous mucormycosis [11]. Pulmonary mucormycosis infection is one of the most common types of infections in patients with mucormycosis, and its nonspecific symptoms include fever, cough, dyspnea, and chest pain [12].…”

Delineating the SARS-CoV-2 Induced Interplay between the Host Immune System and the DNA Damage Response Network

“…Moreover, cancer cells evade attacks from the immune system by inhibiting antigen recognition and creating an immunosuppressive tumor microenvironment [ 87 ]. In addition, chemotherapy suppresses the bone marrow and causes lymphopenia, neutropenia, and thrombocytopenia, thus resulting in susceptibility to infections, such as SARS-CoV-2 [ 92 , 93 , 94 ]. Particularly, lymphopenia makes the patient highly vulnerable to viral infection, which becomes more pronounced when COVID-19-associated lymphopenia is added to the situation, producing severe disease.…”

SEOM clinical guidelines for the prophylaxis of infectious diseases in cancer patients (2021)

“…Cancer incidence is steadily increasing, and while anticancer therapies are evolving, infections are still responsible for significant morbi-mortality in patients with cancer, owing to a greater risk of infection and a certain degree of immunosuppression [ 1 , 2 ].…”

“…For instance, in patients with advanced non-small cell lung cancer, systemic immunosuppression has been characterized by an increased number of myeloid-derived suppressor cells (MDSCs), regulatory T lymphocytes, and immunosuppressive cytokines [ 3 ], and in patients with colorectal carcinoma, a systemic inflammatory response that promotes an immunosuppressive environment has also been described [ 4 ]. Other factors related to advanced solid tumors, such as malnutrition, comorbidities, smoking, systemic inflammation and obstruction of anatomical structures, also contribute to a higher risk of infection [ 2 ]. In addition, disruption of natural defensive barriers, as in the case of mucositis, is an important promoter of infections in patients with cancer on active treatment.…”