Infections in patients with hematologic neoplasms and hematopoietic stem cell transplantation: neutropenia, humoral, and splenic defects.

Safdar A, Armstrong D.

Clin Infect Dis. 2011 Oct;53(8):798-806.

Infections are common in patients with hematologic neoplasms and following allogeneic hematopoietic transplantation. Neutropenia and defects in adaptiveB-cell-mediated immunity and/or lack of splenic function predispose patients to a
host of diverse and often serious infections. It is important to recognize that patients who undergo treatment for hematologic neoplasms may have mixed immune defects, and their vulnerability to infection may continue to change, in part as
a reflection of the dynamic developments in the practice of oncology. The main obstacle in providing targeted, evidence-based antimicrobial treatment is the unpredictable results of even the new generation of diagnostic assays. A definite
diagnosis for most end-organ opportunistic diseases requires tissue samples that  are seldom available. Because immune defects may coexist, empirical therapy is directed toward a wide spectrum of pathogens. Real-time information about innate
and adaptive immune functions and the role of acute and chronic phase molecules may improve target-specific therapy.