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Listeriosis after fludarabine treatment for chronic lymphocytic leukemia
O Hequet1, J P de Jaureguiberry, D Jaubert
1Department of Oncology/Haematology, HIA Sainte-Anne, Toulon Naval, France.
Insights
Fludarabine monotherapy can cause severe Listeria monocytogenes septicemia in chronic lymphocytic leukemia (CLL) patients. Prophylaxis with cotrimoxazole should be considered for CLL patients undergoing fludarabine treatment.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Chronic lymphocytic leukemia (CLL) is a hematologic malignancy often treated with chemotherapy.
- Fludarabine is a purine analog commonly used in CLL treatment, known to cause immunosuppression.
Observation:
- A patient with advanced CLL developed severe Listeria monocytogenes septicemia following a single course of fludarabine.
- The patient had no other immunosuppressive therapies, such as corticosteroids, indicating fludarabine as the likely cause.
Findings:
- Fludarabine's immunosuppressive effects can be profound, especially in already immunocompromised CLL patients.
- Opportunistic infections, including listeriosis and Pneumocystis carinii pneumonia, are known risks during and after purine analog therapy.
Implications:
- The diagnostic and therapeutic management of CLL patients treated with fludarabine must account for its potent immunosuppressive action.
- Prophylaxis with cotrimoxazole should be strongly considered for CLL patients receiving fludarabine to prevent severe infections like listeriosis.
Abstract:
The authors report a case of Listeria monocytogenes septicemia in a patient with advanced CLL after a single course of fludarabine, without any other immunosuppressive therapy e.g. corticosteroids. The immunosuppressive action of fludarabine in patients who are already severely immunosuppressed must be considered from a diagnostic and therapeutic point of view. Listeriosis and other opportunistic infections, like pneumocystis carinii pneumonia, have been reported during and after treatment with purine analogues. Prophylaxis with cotrimoxazole must therefore be discussed in patients with CLL treated with fludarabine.