Infections in Hematologic Malignancy

Abstract

Two decades have elapsed since the first detailed studies were undertaken to determine which factors were associated with an increased incidence of life-threatening sepsis during the treatment of leukemia and lymphoma. The state of granulocytopenia is now acknowledged to be the major factor predisposing to infection and accordingly, attention has focused on the merits of preventive measures applied during this risk period. A tremendous effort has been invested in the evaluation of different protocols and there is little doubt that major advances have been made even though a simultaneous improvement in survival rates as a result of more intensive chemotherapy has not always been in evidence. While it is appropriate to initiate prophylaxis before the treatment of most adult acute leukemias and for marrow transplantation, the reduced duration and severity of granulocytopenia during chemotherapy for both childhood acute leukemia and lymphoma generally obviate the need for this approach.Progress in the development of potent broad-spectrum antibiotics coupled with better clinical awareness of the value of early treatment, as well as changing practices in supportive care have each contributed to the recent pattern of infection that has been observed. In addition, the impact of new technologies, as illustrated by recent innovative applications of bone marrow transplantation, further underlines the need to reappraise current infection control procedures.