Original Article

You have full text access to this OnlineOpen article

Frequency and type of serious infections in fludarabine-refractory B-cell chronic lymphocytic leukemia and small lymphocytic lymphoma

Implications for clinical trials in this patient population

  1. Jeremy G. Perkins M.D.1,
  2. Joseph M. Flynn D.O.1,
  3. Robin S. Howard M.A.2,
  4. John C. Byrd M.D.3,†,*

Article first published online: 4 APR 2002

DOI: 10.1002/cncr.0680

Issue

Cancer

Cancer

Volume 94, Issue 7, pages 2033–2039, 1 April 2002

Additional Information

How to Cite

Perkins, J. G., Flynn, J. M., Howard, R. S. and Byrd, J. C. (2002), Frequency and type of serious infections in fludarabine-refractory B-cell chronic lymphocytic leukemia and small lymphocytic lymphoma. Cancer, 94: 2033–2039. doi: 10.1002/cncr.0680

Author Information

  1. 1

    Department of Medicine, Walter Reed Army Medical Center, Washington, D.C

  2. 2

    Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, D.C

  3. 3

    Division of Hematology-Oncology, The Ohio State University, Columbus, Ohio

  1. †

    Fax: (614) 293-7526

*Division of Hematology-Oncology, The Ohio State University, B301 Starling Loving Hall, 320 West 10th Avenue, Columbus, Ohio 43210-1240

Publication History

  1. Issue published online: 4 APR 2002
  2. Article first published online: 4 APR 2002
  3. Manuscript Accepted: 13 DEC 2001
  4. Manuscript Revised: 5 JUL 2001
  5. Manuscript Received: 28 DEC 2000

Funded by

  • Chronic Lymphocytic Leukemia Research Consortium. Grant Number: P01 CA81534-02
  • Sidney Kimmel Cancer Research Foundation

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (80K)

Keywords:

  • chronic lymphocytic leukemia;
  • small lymphocytic lymphoma;
  • fludarabine;
  • refractory;
  • infection;
  • retrospective

Fludarabine refractory chronic lymphocytic leukemia/small lymphocytic lymphoma patients are prone to serious infections regardless of therapy given. This needs to be considered when investigating new therapies to prevent abandonment of such agents due to a perceived excess of infectious toxicity.

Abstract

BACKGROUND

Treatments for fludarabine-refractory chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are limited. Most new therapies being examined in fludarabine-refractory patients have shown a high frequency of serious infection. Little data exist regarding the frequency of infections in this population treated with noninvestigational best supportive care therapies.

METHODS

The infectious courses of 27 patients with fludarabine-refractory CLL/SLL were retrospectively reviewed. Fludarabine-refractoriness was defined as either relapse within six months of completion of or failure to respond to fludarabine treatment. Infections were documented after patients met National Cancer Institute criteria for further treatment. Serious infections were defined as infections mandating admission to the hospital for intravenous antibiotics.

RESULTS

Patient characteristics included: median age 67 years (range, 40–83), median 3 chemotherapy treatments (range, 1–8), and hypogammaglobulinemia in 73% of patients. Pneumocystis carinii prophylaxis was given to 89% of patients. Serious infections developed in 24 out of 27 patients (89%). Patients had a median of 2 admissions (range, 0–11) for serious infection occurring at a median of 4 months (range, 0–21) from onset of fludarabine-refractoriness. The median frequency of admission for infection was 0.17 per month. Most common sites for infection in decreasing frequency were: respiratory tract, urinary tract, blood/sepsis, and soft tissues. Bacteria caused 69 out of 88 infections (78.4%); viruses (varicella-zoster and herpes simplex) caused 11 out of 88 (12.5%); fungi caused 4 out of 88 (4.5%); and opportunistic infections caused 4 out of 88 (4.5%). Median survival was 13.0 months (range, 1–44+).

CONCLUSIONS

The frequency of serious infections in patients with fludarabine-refractory CLL/SLL is high. These findings are relevant to trials with new and highly effective agents for which the incidence of serious infections after treatment might otherwise appear to be prohibitively high. Cancer 2002;94:2033–9. © 2002 American Cancer Society.

DOI 10.1002/cncr.10437

View Full Article (HTML) Get PDF (80K)