Preventing infectious complications when treating non-malignant immune-mediated hematologic disorders

Area of Science:

• Hematology
• Immunology
• Infectious Diseases

Background:

• Immune-mediated non-malignant hematologic disorders are treated with immunosuppressants, targeted antibody therapies, and splenectomy.
• Infection is a significant non-hematological adverse event associated with these treatments.
• Corticosteroids increase infection risk in a dose- and duration-dependent manner, including opportunistic infections.

Purpose of the Study:

• To summarize existing guidelines on immunizations and prophylactic antimicrobial therapies for patients on immunosuppressive agents.
• To provide clinical management suggestions for situations lacking formal guidelines.
• To highlight key infection risks and preventive strategies associated with specific immunosuppressive therapies.

Main Methods:

• Review and synthesis of federal and society guidelines regarding infection prevention in immunosuppressed patients.
• Identification of specific screening and prophylaxis recommendations for agents like corticosteroids, rituximab, and eculizumab.
• Compilation of information into a clinical-focused table for practical application.

Main Results:

• Screening and prophylaxis for tuberculosis, Strongyloides stercoralis, and Pneumocystis jirovecii pneumonia are recommended for selected patients on steroids.
• Hepatitis B virus reactivation screening and potential antiviral prophylaxis are necessary for patients starting rituximab.
• Meningococcal immunization is recommended for eculizumab-treated patients, with some guidelines suggesting antibiotic prophylaxis.

Conclusions:

• Comprehensive screening, immunization, and antimicrobial prophylaxis are essential for managing infection risks in patients with hematologic disorders undergoing immunosuppressive therapy.
• Adherence to guidelines and proactive management are critical for preventing serious infections.
• The manuscript provides a valuable resource for clinicians managing immunosuppressed patients, offering practical guidance for infection prevention.