Infectious complications of patients undergoing therapy for acute leukemia: Current status and future prospects

S. J. Chanock, P. A. Pizzo

Research output: Contribution to journalArticle

Abstract

The success of managing the infectious complications of acute leukemia has permitted oncologists to develop new approaches to induction and high- dose therapy. The single most important risk factor for infection is the duration of absolute neutropenia. Historically, most attention was directed towards gram negative aerobes, especially Pseudomonas aeruginosa, but in recent years gram positive bacteria, generally considered to be less virulent, have become the most frequent isolates in most centers. A recent disturbing trend is the isolation of vancomycin-resistant enterococci. A recent controversy has been whether to use empirical vancomycin; the Centers for Disease Control has issued a formal recommendation discouraging empirical vancomycin in the febrile neutropenic patient. Empirical monotherapy has replaced combination therapy in many institutions except where there has been an increase in resistant isolates. In patients who remain profoundly neutropenic, fungal infections represent a serious source of secondary infection, especially species of Candida and Aspergillus. Recently lipid- based formulations of amphotericin B have offered reduced nephrotoxicity. Less toxic antifungals, the azoles, which include fluconazole and itraconazole, offer an attractive alternative to amphotericin B. New patterns of invasive mycoses have emerged, as for example hepatosplenic candidiasis, presenting new problems in diagnosis and therapy. The successful management of virus infections with herpes simplex, cytomegalovirus, varicella zoster, and Epstein Barr virus is based on early recognition and careful attention to prevention.

Original languageEnglish (US)
Pages (from-to)132-140
Number of pages9
JournalSeminars in Oncology
Volume24
Issue number1
StatePublished - 1997
Externally publishedYes

Fingerprint

Leukemia
Amphotericin B
Vancomycin
Azoles
Herpes Simplex
Itraconazole
Chickenpox
Mycoses
Fluconazole
Candidiasis
Poisons
Herpes Zoster
Gram-Positive Bacteria
Virus Diseases
Aspergillus
Centers for Disease Control and Prevention (U.S.)
Neutropenia
Cytomegalovirus
Human Herpesvirus 4
Coinfection

ASJC Scopus subject areas

  • Oncology

Cite this

Infectious complications of patients undergoing therapy for acute leukemia : Current status and future prospects. / Chanock, S. J.; Pizzo, P. A.

In: Seminars in Oncology, Vol. 24, No. 1, 1997, p. 132-140.

Research output: Contribution to journalArticle

@article{a4294b92e4de4cbba00132cd103867d7,
title = "Infectious complications of patients undergoing therapy for acute leukemia: Current status and future prospects",
abstract = "The success of managing the infectious complications of acute leukemia has permitted oncologists to develop new approaches to induction and high- dose therapy. The single most important risk factor for infection is the duration of absolute neutropenia. Historically, most attention was directed towards gram negative aerobes, especially Pseudomonas aeruginosa, but in recent years gram positive bacteria, generally considered to be less virulent, have become the most frequent isolates in most centers. A recent disturbing trend is the isolation of vancomycin-resistant enterococci. A recent controversy has been whether to use empirical vancomycin; the Centers for Disease Control has issued a formal recommendation discouraging empirical vancomycin in the febrile neutropenic patient. Empirical monotherapy has replaced combination therapy in many institutions except where there has been an increase in resistant isolates. In patients who remain profoundly neutropenic, fungal infections represent a serious source of secondary infection, especially species of Candida and Aspergillus. Recently lipid- based formulations of amphotericin B have offered reduced nephrotoxicity. Less toxic antifungals, the azoles, which include fluconazole and itraconazole, offer an attractive alternative to amphotericin B. New patterns of invasive mycoses have emerged, as for example hepatosplenic candidiasis, presenting new problems in diagnosis and therapy. The successful management of virus infections with herpes simplex, cytomegalovirus, varicella zoster, and Epstein Barr virus is based on early recognition and careful attention to prevention.",
author = "Chanock, {S. J.} and Pizzo, {P. A.}",
year = "1997",
language = "English (US)",
volume = "24",
pages = "132--140",
journal = "Seminars in Oncology",
issn = "0093-7754",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Infectious complications of patients undergoing therapy for acute leukemia

T2 - Current status and future prospects

AU - Chanock, S. J.

AU - Pizzo, P. A.

PY - 1997

Y1 - 1997

N2 - The success of managing the infectious complications of acute leukemia has permitted oncologists to develop new approaches to induction and high- dose therapy. The single most important risk factor for infection is the duration of absolute neutropenia. Historically, most attention was directed towards gram negative aerobes, especially Pseudomonas aeruginosa, but in recent years gram positive bacteria, generally considered to be less virulent, have become the most frequent isolates in most centers. A recent disturbing trend is the isolation of vancomycin-resistant enterococci. A recent controversy has been whether to use empirical vancomycin; the Centers for Disease Control has issued a formal recommendation discouraging empirical vancomycin in the febrile neutropenic patient. Empirical monotherapy has replaced combination therapy in many institutions except where there has been an increase in resistant isolates. In patients who remain profoundly neutropenic, fungal infections represent a serious source of secondary infection, especially species of Candida and Aspergillus. Recently lipid- based formulations of amphotericin B have offered reduced nephrotoxicity. Less toxic antifungals, the azoles, which include fluconazole and itraconazole, offer an attractive alternative to amphotericin B. New patterns of invasive mycoses have emerged, as for example hepatosplenic candidiasis, presenting new problems in diagnosis and therapy. The successful management of virus infections with herpes simplex, cytomegalovirus, varicella zoster, and Epstein Barr virus is based on early recognition and careful attention to prevention.

AB - The success of managing the infectious complications of acute leukemia has permitted oncologists to develop new approaches to induction and high- dose therapy. The single most important risk factor for infection is the duration of absolute neutropenia. Historically, most attention was directed towards gram negative aerobes, especially Pseudomonas aeruginosa, but in recent years gram positive bacteria, generally considered to be less virulent, have become the most frequent isolates in most centers. A recent disturbing trend is the isolation of vancomycin-resistant enterococci. A recent controversy has been whether to use empirical vancomycin; the Centers for Disease Control has issued a formal recommendation discouraging empirical vancomycin in the febrile neutropenic patient. Empirical monotherapy has replaced combination therapy in many institutions except where there has been an increase in resistant isolates. In patients who remain profoundly neutropenic, fungal infections represent a serious source of secondary infection, especially species of Candida and Aspergillus. Recently lipid- based formulations of amphotericin B have offered reduced nephrotoxicity. Less toxic antifungals, the azoles, which include fluconazole and itraconazole, offer an attractive alternative to amphotericin B. New patterns of invasive mycoses have emerged, as for example hepatosplenic candidiasis, presenting new problems in diagnosis and therapy. The successful management of virus infections with herpes simplex, cytomegalovirus, varicella zoster, and Epstein Barr virus is based on early recognition and careful attention to prevention.

UR - http://www.scopus.com/inward/record.url?scp=0031052545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031052545&partnerID=8YFLogxK

M3 - Article

C2 - 9045299

AN - SCOPUS:0031052545

VL - 24

SP - 132

EP - 140

JO - Seminars in Oncology

JF - Seminars in Oncology

SN - 0093-7754

IS - 1

ER -