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welcome

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  • Presenter
  • Dr. sharup chandra poddar
  • Resident phase-B
  • Department of haematology
  • BSMMU

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Introduction :

  • There is an increase risk of infection in patients with cancer that results in higher mortality and morbidity.

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  • The malignancy itself can predispose patients to severe or reccurent infections.

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  • Neutropenia has been recognized as a major risks factors for the developments of infections in patients with cancer undergoing chemotherapy.

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  • Although neutropenia remains a key risk factor for infections, other immunocompromised states pose at least equal risk.

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  • Allogenic HCT recipients with neutrophil recovery who require intensive immunosuppressive (IST) therapy for graft vs host disease (GVHD) are an example of non-neutropenic patients at great risk for common bacterial,viral and opportunistic infections.

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Objectives:

  • To identify risk factors and risk stratification of infections in cancer patients

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  • To know pathogenic organisms and their spectrum of disease and diagnosis

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  • To know about infection prevention and treatment in cancer patients.

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Hosts factors that predispose patients to infectious complications :

  • Immunodeficiencies associated with primary malignancy:

Acute leukaemia,NHL,MDS,CLL,MM

  • Neutropenia:

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  • Disruptions of mucosal barriers:

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  • Splenectomy and functional asplenia:

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  • Corticosteroids and other immunosuppressive therapy:

Corticosteroid: >20 mg prednisolone

Purine analogue therapies: Lypmhotoxic (cd4+)

Alemtuzumab: Deplet lymphocytes in allogenic HCT and CLL patients.

Anti-CD20 monoclonal Ab: (rituximab,ofatumumab) -

HBV reactivation, PML(JC virus)

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  • Others immunosuppressive therapies:

Idealisib+rituximab - Pneumocystis jirovecii

Ibrutinib+bendamustine - Pneumocystis jirovecii

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Haematopoetic stem cell transplant

  • Autologus HCT:

Have fewer infectious complications than allogenic HCT

  • Allogenic HCT:

Have more chance of infections due to prolong and severe immunosuppression

  • Chronic GVHD:

Associated with persistently depressed cell mediated and humoral immunity - pneumococcal infection

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Summary:

  • In summary ,prevention and treatment of infections in patients with cancer is a complex and continuously evolving field.

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  • How ever, these advances in treatment have only further emphasized the need for multidisciplinary care.

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  • The NCCN guidelines for prevention and treatment of cancer- related infections aim to provide an overview of the risk categorization and recommended strategies for prevention of infections in high – risk population, and recommendations for empiric therapy, evaluation, follow-up, and monitoring in patients with signs and/or symptoms of infections.

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  • Indivisualized risk evaluation for infections incorporations of preventative measures, and prompt identification and treatment of active infections are essential components of overall spectrum of care in cancer management, and can contribute to optimizing treatment outcomes in patients with cancer.

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