Moran, M., Browning, M., & Buckby, E. (2007). Nursing guidelines for managing infections in patients with chronic lymphocytic leukemia. Clinical Journal of Oncology Nursing, 11, 914–924.

Patients with chronic lymphocytic leukemia (CLL) were assessed.

No process development or search strategy were stated.

Information was provided by the authors in regards to current trends in CLL treatment and the risk of infection that is present with the most common current treatments, such as fludarabine, rituximab, alemtuzumab, and steroids. Specific bacterial and fungal infections that are most commonly associated with treatment were discussed as well as the prevention and management of these infections. A table was provided that had the most commonly occurring infections; chemotherapy treatment most commonly associated with each infection, prophylaxis, treatment options for the infection with duration and side effects; and nursing interventions. Discussion also was included on monoclonal antibodies and risk of opportunistic infection due to immune incompetency from these agents.

• Patients with CLL that are being treated should have appropriate surveillance and examination in regard to assessing for infection, related to their specific treatment therapy. A patient with CLL with a fever should always be considered infected until proven otherwise.
• Patients receiving frontline fludarabine therapy should receive antiviral prophylaxis with famciclovir 500 mg PO BID, valacyclovir 500 mg PO qid or acyclovir 400 mg PO BID during therapy and for up to six months after therapy. Prophylactic antibiotic or antifungal therapy is not currently recommended for patients receiving fludarabine.
• Routine anti-infective prophylaxis is not recommended for patients receiving rituximab monotherapy.
• Routine anti-infective prophylaxis for patients receiving alemtuzumab is recommended, specifically trimethoprim/sulfamethoxazole (TMP/SMX) DS, TIW forprophylaxis against PCP and famciclovir, acyclovir, valacyclovir,or equivalent for antiviral prophylaxis. This therapy should continue for at least two months after treatment ends or until CD4 count recovers to 200 cells/mcl or greater. Patients should also be monitored weekly for CMV using CMV PCR serum assays.
• Patients who have an absolute neutrophil count (ANC) less than 500 and receiving alemtuzumab should receive G-CSF as prophylaxis.
• For patients with relapsed or refractory CLL receiving chemo-immunotherapy combination medications, routine incorporation of anti-infective prophylaxis may be necessary to minimize severe infection.
• If a CLL patient has a history of hepatitis B, prophylaxis with lamivudine 100 mg PO qid should begin four weeks prior to therapy, continue during therapy, and up to six months following therapy.
• No routine antifungal prophylaxis is recommended for patients with CLL.
• Patients with CLL should receive PCP prophylaxis with TMP/SMX DS TIW (alternatives are dapsone 100 mg PO five days per week), nebulized pentamadine 300 mg PO, or atovaquone 750 mg PO BID) beginning at the start of therapy and continuing for 6–12 months after therapy or until CD4 count is greater than 250 cells/mcl.
• Patients with CLL should receive vaccinations with attenuated vaccines.

No conflicts of interest were identified.

Combinations of antibacterial, antiviral, and antifungal prophylactic medications may be appropriate in patients with CLL being treated with various chemotherapy regimens to prevent a life threatening infection from occurring and the type and duration is dependent on the agents they are receiving.