Abtract
Patients with hematological malignancies such as leukemias and lymphomas are predisposed to a wide spectrum of infections that need special attention. These patients are immunosuppressed not only as a result of the immune defects associated with the underlying disease, but also because of the treatment regimens that generally further decrease the patient’s resistance to infections. An intensive transfusion support with platelets, red cell concentrates, immunoglobulins, cytokines, and other drugs is necessary. Many patients also need antiemetic agents, nutritional support, pain medication, and, very often, venous catheters. All of these measures are considered supportive care and apply in a similar fashion to the high-dose treatment of solid tumors. Supportive care measures, along with the treatment and prophylaxis of infections, are discussed in this chapter. Transfusion support is discussed in Chapter 22.
Chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Bodey GP, Buckley M, Sathe YS, et al. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64:328–340.
Pizzo PA. Fever in immunocompromised patients. N Engl J Med 1999; 341:893–900.
Donowitz GR, Maki DG, Crnich CJ, Pappas PG, Roloston KV. Infections in the neutropenic patient—new views of an old problem. Hematology 2001;113–139.
Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34:730–751.
de Pauw BE, Donnelly JP. Infections in the immunocompromised host: general principles. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practices of Infectious Diseases, 5th ed. Philadelphia: Churchill Livingston, 2000:pp. 3079–3090.
Bodey GP. Unusual presentations of infection in neutropenic patients. Int J Antimicrob Agents 2000; 16:93–95.
DesJardin JA, Falagas ME, Ruthazer R, et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Ann Intern Med 1999; 131:641–647.
Caillot D, Couaillier J-F, Bernard A, et al. Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with neutropenia. J Clin Oncol 2001; 19:253–259.
Pazos C, Ponton J, Del Palacio A. Contribution of (1–3) beta-D-glucan chromogenic assay to diagnosis and monitoring of invasive aspergillosis in neutropenic adult patients. J Clin Microbiol 2005; 43:299–305.
Pinel C, Fricker-Hidalgo H, Lebeau B, et al. Detection of circulating Aspergillus fumigatus galactomannan value and limits of the Platelia test for diagnosing invasive aspergillosis. J Clin Microbiol 2003; 41:2184–2186.
Walsh TJ, Shoham S, Petraitiene R, et al. Detection of galactomannan antigenemia in patients receiving piperacillin-tazobactam and correlations between in vitro, in vivo, and clinical properties of the drug-antigen interaction. J Clin Microbiol 2004; 42:4744–4748.
Rolston KVI. Stenotrophomonas maltophilia infection in cancer patients-frequency, spectrum of infection and antimicrobial susceptibility. European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2003;Glasgow, Scotland Abs. 678
Safdar N, Maki DO. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aerues, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002; 136:834–844.
Razonable RR, Litzow MR, Kaliq Y, et al. Bacteremia due to viridans group streptococci with diminished susceptibility to levofloxacin among neutropenic patients receiving levofloxacin prophylaxis. Clin Infect Dis 2002; 34:1469–1474.
Jantunen E, Ruutu P, Niskanen L, et al. Incidence and risk factors for invasive fungal infections in allogeneic BMT recipients. Bone Marrow Transplant 1997; 19:801–808
Yuen KY, Woo PCY, Ip MSM, et al. Stage-specific manifestations of mold infections in bone marrow transplant recipients: risk factors and clinical significance of positive concentrated smears. Clin Infect Dis 1997; 25:37–42.
Fukuda T, Boeckh M, Carter RA, et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 2003; 102:827–833.
Keating MJ, Flinn I, Jain V, et al. Therapeutic role of alemtuzumab (Campath-1H) in patients who have failed fludarabine: results of a large international study. Blood 2002; 99:3554–3561.
McNeil MM, Nash SL, Hajjeh RA, et al. Trends in mortality due to invasive mycotic diseases in the United States. 1980/2-1997. Clin Infect Dis 2001; 33:641–647.
Walsh TJ, Groll A, Hiemenz J, et al. Infections due to emerging and uncommon fungal pathogens. Clin Microbiol Infect 2004; 10:48–66.
Ison MG, Hayden FG, Kaiser L, et al. Rhino virus infections in hematopoietic stem cell transplant recipients with pneumonia. Clin Infect Dis 2003;36:1139–1143.
Martino R, Ramila E, Rabella N, et al. Respiratory virus infections in adults with hematologic malignancies: a prospective study. Clin Infect Dis 2003;26:1–8.
Marcolini JA, Malik S, Suki D, et al. Respiratory disease due to parainfluenza virus in adult leukemia patients. Eur J Clin Microbiol Infect Dis 2003;22:79–84.
Freifeld A, Marchigiani D, Walsh T, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low risk febrile patients with neutropenia during cancer chemotherapy. N Eng J Med 1999;341:305–311.
Rolston KVI. New trends in patient management: risk-based therapy for febrile patients with neutropenia. Clin Infect Dis 1999;29:515–521.
Del Favero A, Menichetti F, Marino P, et al. A multicenter, double-blind, placebocontrolled trial comparing piperacillin-tazobactam with and without amikacin as empiric therapy for febrile neutropenia. Clin Infect Dis 2001;33:1295–1301.
Walsh TJ, Hiemenz JW, Anaissie E. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am 1996; 10:365–400.
Pizzo PA, Robichaud KJ, Gill FA, et al. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982;72:101–111.
EORTC International Antimicrobial Therapy Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients. Am J Med 1989;86:668–672.
White MH, Bowden RA, Sandler ES, et al. Randomized, double-blind clinical trial of amphotericin B colloidal dispersion vs. amphotericin B in the empirical treatment of fever and neutropenia. Clin Infect Dis 1998;27:296–302.
Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. N Engl J Med 1999; 340:764–771.
Boogaerts M, Winston DJ, Bow EJ, et al. Intravenous and oral itraconazole versus intravenous amphotericin B deoxycholate as empirical antifungal therapy for persistent fever in neutropenic patients with cancer who are receiving broad-spectrum antibacterial therapy; a randomized controlled trial. Ann Intern Med 2001;135:412–422.
Walsh TJ, Pappas P, Winston DJ, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med 2002;346:225–234.
Walsh TJ, Teppler H, Donowitz GR, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 2004;351(14):1391–1402.
National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report. Data summary from January 1990-May 1999. Am J Infect Control 1999;27:520–532.
National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillence (NNIS) System report. Data summary from January 1992–April 2000. Am J Infect Control 2000;28:429–448.
Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis 2002;34:1524–1529.
Donskey CJ, Chowdhry TK, Hecker MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.
Edmond M, Ober JF, Weinbaum DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.
Patterson DL, Rice LB. Empirical antibiotic choice for the seriously ill patient; are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive? Clin Infect Dis 2003; 36:1006–1012.
National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report. Data summary from January 1992–June 2001. Am J Infect Control 2001;29:404–421.
Stevens DL, Dotter B, Madaras-Kelly K. A review of linezolid: the first oxazolidinone antibiotic. Expert Rev Anti Infect Ther 2004;2:51–59.
Raad I, Hachem R, Hanna H, et al. Prospective randomized study comparing quinupristin with linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections. J Antimicrob Chemother 2004;53:646–649.
Rao N, Ziran BH, Wagener MM, et al. Similar hematologic effects of long-term linezolid and vancomycin in a prospective observational study of patients with orthopedic infections. Clin Infect Dis 2004;38:1058–1064.
Meissner HC, Townsend T, Wenman W, et al. Hematologic effects of linezolid in young children. Pediatr Infect Dis J 2003;22(S19):186–192.
Dibo I, Pillai SK, Gold HS, et al. Linezolid-resistant Enterococcus faecalis isolated from a cord blood transplant recipient. J Clin Microbiol 2004;42:1843–1845.
Pappas PG, Rex JH, Sobel JD, et al. Guidelines for the treatment of candidiasis. Clin Infect Dis 2004;38:161–189.
Walsh TJ, Hiemenz JW, Anaissie E. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am 1996;10:365–400.
Nucci M, Anaissie E. Should vascular catheters be removed from allpatients with candidemia? An evidence-based review. Clin Infect Dis 2002;34:591–599.
Walsh TJ, Rex JH. All catheter-related candidemia is not the same: assessment of the balance between the risks and benefits of removal of vascular catheters. Clin Infect Dis 2002;34:600–602.
Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002;347:2020–2029.
Gerson SL, Talbot GH, Hurwitz S, et al. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med 1984;100:345–351.
Patterson TF, Kirkpatrick WR, White M, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. Medicine (Baltimore) 2000;79:250–60.
Stevens DA, Kan VL, Judson MA, et al. Practice guidelines for diseases caused by Aspergillus. Clin Infect Dis 2000;30:696–709.
Hiemenz JW, Walsh TJ. Lipid formulations of amphotericin B: Recent progress and future directions. Clin Infect Dis 1996;22(S2): pp133-144.
Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408–415.
Caillot D, Mannone L, Cuisenier B, et al. Role of early diagnosis and agressive surgery in the management of invasive pulmonary aspergillosis in neutropenic patients. Clin Microbiol Infect 2001;7(S2):54–61.
Bartizal K, Gill CJ, Abruzzo GK, et al. In vitro preclinical evaluation studies with the echinocandin antifungal MK-0991 (L-743,872). Antimicrob Agents Chemother 1997;41:2326–2332.
Arikan S, Lozano-Chiu M, Paetznick V, et al. In vitro synergy of caspofungin and amphotericin B against Aspergillus and Fusarium spp. Antimicrob Agents Chemother 2002;46:245–247.
Perea S, Gonzalez G, Fothergill AW, et al. In vitro interaction of caspofungin acetate with voriconazole against clinical isolates of Aspergillus spp. Antimicrob Agents Chemother 2002;46:3039–3041.
Kirkpatrick WR, Perea S, Coco B J, et al. Efficacy of caspofungin alone and in combination with voriconazole in a guinea pig model of invasive aspergillosis. Antimicrob Agents Chemother 2002;46:2564–25
Petraitis V, Petraitiene R, Sarafandi AA, et al. Combination therapy in treatment of experimental pulmonary aspergillosis: synergistic interaction between an antifungal triazole and an echinocandin. J Infect Dis 2003;187:1834–1843.
Aliff TB, Maslak PG, Jurcic JG, et al. Refractory aspergillus pneumonia in patients with acute leukemia. Successful therapy with combination caspofungin and liposomal amphotericin. Cancer 2003; 97:1025–1032.
Kontoyiannis DP, Hachem R, Lewis RE, et al. Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients with hematological malignancies. Cancer 2003; 98:292–299.
Marr KA, Boeckh M, Carter RA, et al. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 2004;39:797–802.
Sherertz RJ, Belani A, Kramer BS, et al. Impact of air filtration on nosocomial aspergillus infections. Unique risk of bone marrow transplant recipients. Am J Med 1987; 83:7109–7718.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Hiemenz, J., Munker, R. (2007). Supportive Care in Hematology. In: Munker, R., Hiller, E., Glass, J., Paquette, R. (eds) Modern Hematology. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-149-9_3
Download citation
DOI: https://doi.org/10.1007/978-1-59745-149-9_3
Publisher Name: Humana Press
Print ISBN: 978-1-58829-557-6
Online ISBN: 978-1-59745-149-9
eBook Packages: MedicineMedicine (R0)