PROPHYLACTIC STRATEGIES TO MEET INFECTIOUS COMPLICATIONS IN FLUDARABINE-TREATED CLL

Fludarabine has emerged as salvage therapy in chlorambucil-resistant C LL. However, encouraging response rates have been compromised by a hig h incidence of serious infectious complications. Prophylactic measures to reduce the frequency of infections are needed, but up to now, ther e are no established standards for supportive therapy in fludarabine-t reated CLL. Clinicians have observed an increasing frequency of life-t hreatening opportunistic infections but only some of these may be expl ained by fludarabine-induced impairment of cell-mediated immunity. Neu trocytopenia commonly found during initial fludarabine treatment may n ot have been addressed sufficiently as risk factor for infections. Thu s, G-CSF supplementation may improve the rate of infectious complicati ons by reducing the duration of fludarabine-induced neutrocytopenia. T he changing spectrum of infectious complications should stimulate addi tional trials on the value of IVIG replacement in fludarabine-treated CLL patients and on the role of low-dose co-trimoxazole in patients at high risk of Pneumocystis carinii infections.