Category: Patient Education

Lymphoma and Infection: Do I Need to Take Medication to Prevent Infection?

By Jessica Lewis, PA

In some instances, patients may be started on medicines to prevent or minimize infection. Infection in patients with impaired immune system function (due to lymphoma or treatment of lymphoma) can be life threatening. Ultimately, your doctor will determine whether to start such medications, but some current literature helps medical providers make this decision. The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance between 21 different cancer-treating centers within the USA. Research generated from physicians in these institutions is used to develop evidence-based recommendations to help guide healthcare providers. The American Society of Clinical Oncology (ASCO) is a not-for-profit group of physicians, who focus on patient-oriented clinical research, education, prevention, and delivery of patient care.

The NCCN and ASCO provide summaries of factors that predict a lymphoma patient’s risk of developing fever and infection. These factors include age, performance status, type of cancer, status of disease (remission vs. active disease), type of treatment, the presence of a low infection-fighting white blood cell count (neutropenic), and prior episodes of fever with chemotherapy treatment. Patients with lymphoma are generally classified as having intermediate risk, although some patients with CLL or T-cell lymphoma may be considered high risk.

Prevention of bacterial infections: Common prophylactic medications include levofloxacin or ciprofloxacin. Prophylaxis is recommended for intermediate or high-risk patients, including patients that are expected to have neutropenia. There have been few randomized-controlled trials that have investigated the use of antibiotics to prevent development of fever and infection in lymphoma patients that are receiving chemotherapy. The largest randomized-controlled study, by Cullen et al in 2005, included 1,565 patients with solid cancers and lymphomas treated with chemotherapy that would lower the white blood cell count.  In this study, patients were randomly assigned a placebo or levofloxacin. The authors found a decrease in the incidence of fever and decreased rates of probable infection and hospitalization. However, patients who received levofloxacin did not have a statistically significant decreased rate of severe infection (including lethal infections). As per 2012 NCCN and ASCO guidelines, the use of levofloxacin prophylaxis is only recommended for patients with neutropenia that lasts longer than 7 days.

Prevention of fungal infections: Medications to prevent fungal infections are not usually needed in lymphoma patients. ASCO guidelines recommend considering prophylaxis only for patients with profoundly low white blood cell counts (ANC <100) longer than 7 days. Additionally, patients should limit exposure to construction or demolition sites, and quit cigarette smoking to reduce risk of fungal infections.

Prevention of viral infections: Antiviral medications may be recommended. If you have been exposed to hepatitis B infection, you may be started on medication to prevent this from becoming an active infection. If you had the chicken pox as a child you are at risk of developing shingles, and you may benefit from preventative medication. Patients with lymphoma should not receive the shingles vaccine.

PCP prevention: Some patients are at risk of developing pneumonia, caused by Pneumocytus jirovecii (also referred to as PCP). You may require preventative medication, typically with TMP-SMX, if you are on steroids for a prolonged period of time (>1 month), or are receiving treatment with alemtuzumab or purine analogs (i.e., fludarabine).

Other preventative measures: ASCO 2012 guidelines recommended all patients who are receiving cancer treatment to receive the seasonal flu vaccine, along with their family and household contacts. Guidelines from the Centers for Disease Control (CDC) include administration of a pneumococcal vaccine in all patients with lymphoma.

Clinical Trials FAQ

Are you interested in participating in a lymphoma clinical trial, but unsure of what a clinical trial encompasses?

If so, then please click here for our recently added Clinical Trials FAQ. This page is useful for addressing the concerns and misconceptions regarding clinical trials by outlining their basic structure and requirements in the Lymphoma Program at Weill Cornell Medical College.

Here at Weill Cornell we are dedicated to providing the best in patient care, while working towards the ultimate goal of finding a cure for lymphoma. Clinical trials are one of the many tools we use to help accomplish these dual goals. For a full listing of all current clinical trials underway in the Lymphoma Program, please click here.

New Treatment for Systemic and Cutaneous T-cell Lymphomas: Antibody-drug Conjugate Brentuximab Vedotin

jruanBy Jia Ruan, MD

The peripheral T-cell lymphomas (PTCL) are uncommon lymphoid diseases that account for 5-10% of all non-Hodgkin lymphomas in adults in North America.  Compared to B-cell non-Hodgkin lymphomas, the PTCLs are generally aggressive and less responsive to current treatment options. Relapsed and refractory diseases are common.  Novel and target therapies are in much need to improve quality and duration of response.  At the 2012 American Society of Hematology (ASH) meeting in Atlanta, several research groups reported encouraging study results with the antibody-drug conjugate Brentuximab vedotin for T-cell lymphomas. Brentuximab vedotin (BV) is an anti-CD30 chimeric antibody conjugated by a protease-cleavable linker to the microtubule-disrupting agent monomethyl auristatin E. BV received accelerated FDA approval in 2011 for relapsed Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (ALCL), 2 diseases that express abundant CD30.  Several new studies have looked at the treatment outcome of BV in patients with systemic or cutaneous T-cell lymphomas that express variable amount of CD30.

Studies in Systemic T-cell Lymphomas

Dr. Jacobsen from Dana Farber Cancer Institute reported an interim analysis of a phase II multicenter study which evaluated the antitumor activity of BV in patients with relapsed or refractory CD30-positive NHL. BV was administered at 1.8 mg/kg every 3 weeks by IV infusion. The study also explored the correlation between antitumor activity and quantitative CD30 expression.  Fifty-three patients with various CD30-positive NHLs have been enrolled, including 18 patients with mature T-/NK-cell lymphomas. Of the T-cell lymphoma patients enrolled, 9 have angioimmunoblastic T-cell lymphoma (AITL), 8 have PTCL-NOS, and 1 has cutaneous T-cell lymphoma.  The ORR was 27% (3/11) for mature T-/NK-cell NHLs.  Thus far, response was particularly noteworthy in in AITL where 3 of 5 patients (60%) have responded (2 CR, 1 PR).   Treatment-emergent adverse events were generally mild and moderate (grade 1/2), and expected including peripheral neuropathy and cytopenias, which was consistent with the safety profile of BV.  CD30 expression levels for patients with a CR or PR were widely variable and ranged from <1% to 90%.  Preliminary data seems to suggest that BV may be beneficial for patients with T-cell lymphomas that have low CD30 expression. Dr. Fanale from MD Anderson Cancer Center reported a phase I study with BV administered concurrently with multi-agent chemotherapy as frontline treatment of systemic ALCL and other CD30 positive T-cell lymphomas.  The study was Continue reading “New Treatment for Systemic and Cutaneous T-cell Lymphomas: Antibody-drug Conjugate Brentuximab Vedotin”