A Systematic Review on the Prevention and Control of Opportunistic Infections in Patients With Chronic Lymphocytic Leukemia Complicated by Richter's Transformation.

Hadia Arzoun,Mirra Srinivasan,Bridget Lee,Stephanie Sandoval

doi:10.7759/cureus.22927

Abstract

Chronic lymphocytic leukemia (CLL) is one of the most commonly occurring types of leukemia among the elderly population, contributing to an increased vulnerability to infections that are especially prolific in the immunosuppressed and the risk of rapid progression of the disease into a more aggressive manifestation of large cell lymphoma, a process called Richter’s Transformation (RT). CLL alone predisposes patients to develop infections; however, the additional complication of RT decreases survival and makes the prevention and control of infection for the CLL patient even more challenging. However, research that exists on preventing and controlling infection in CLL patients with RT is relatively limited. In most cases, studies have focused on the prevention of infection in CLL patients in general and with no reference to the progression of RT.Considering the dearth of research on infection prevention and control for patients with CLL complicated by RT specifically, the following review examines existing research in addressing the prevention and control of infection in CLL patients with RT and patients in general. The authors explored multiple databases such as PubMed, Google Scholar, and Science Direct. The ultimate focus of this study was to lay a fundamental understanding in preventing and controlling infection in CLL patients. After analyzing several studies, it can be concluded that identifying infections, even if rare, is a crucial aspect of managing CLL patients. A broad range of differential diagnoses should be sought in cases presenting with refractory CLL as well and management of infections before, during, or after CLL treatment should be considered.

Highlights

BackgroundBy its simplest definition, chronic lymphocytic leukemia (CLL) manifests in the “clonal proliferation and accumulation of mature and typically CD5-positive B-cells in the blood, bone marrow, lymph nodes, and spleen” [1]
Infection prevention and control is especially critical in CLL patients because it manifests predominantly in elderly adults, increasing their vulnerability to opportunistic infections and complications leading to death
This review mainly focuses on the prevention aspect of infection in CLL patients, especially in the vulnerable population, and does not discuss other complications or clinical features of CLL

Summary

Introduction

Chronic lymphocytic leukemia (CLL) manifests in the “clonal proliferation and accumulation of mature and typically CD5-positive B-cells in the blood, bone marrow, lymph nodes, and spleen” [1]. Infection prevention and control is especially critical in CLL patients because it manifests predominantly in elderly adults, increasing their vulnerability to opportunistic infections and complications leading to death. Considering that infection prevention and control protocols are imperative for the CLL patient with or without a “large volume of readily available primary tumor cells,”. CLL patients are in an immunosuppressed state regardless of stage and incidence of RT, with any difference in how the prevention and control of infection are meted out in its progression being dependent on the. Arzoun H, Srinivasan M, Sandoval S, et al (March 07, 2022) A Systematic Review on the Prevention and Control of Opportunistic Infections in Patients With Chronic Lymphocytic Leukemia Complicated by Richter’s Transformation. An investigation of how those differences might look in terms of infection prevention and protocols follows

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