Neutrophil Function in Hematological Neoplasia

Though the main reason for infection in hematologic malignancies remains the reduction in the neutrophil count, there are certain conditions where agranulocytosis alone could not account for this tendency. In non lymphatic disorders, obvious modifications in mature neutrophil functions have been described. They predict susceptibility to infection and bad prognosis in myelodysplastic syndromes (MDS) and in acute non lymphatic leukemia (ANLL) where the mature looking neutrophils represent the leukemic clone and function aberrantly. The defects in neutrophil function encountered in myeloproliferative diseases including chronic myeloid leukemia, are mostly of scientific interest, and usually do not alter the clinical course of the disease in these patients. The alterations in neutrophil function in the lymphoproliferative disorders result mostly from humoral defects, mainly immunoglobulin deficiency and a variety of neutrophil inhibitory substances, and are not due to primary cellular defects. Neutrophil dysfunction may also result from a protracted infectious course and various treatment modalities, includng splenectomy and chemo-radiotherapy. Neutrophil function studies in splenectomised patients and in selected cases with MDS and ANLL, and studies of serum immunoglobulins and neutrophil inhibitors in patients with lymphoid diseases, may be useful in screening those cases who are prone to infectious problems, and who might therefore benefit from increased infectious precautions.