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.

LLS Patient Education: A Special Evening with Experts from Weill Cornell and Memorial Sloan-Kettering

New Developments in Lymphoma:
A Special Evening with Experts from Weill Cornell Cancer Center
and Memorial Sloan-Kettering Cancer Center

The Leukemia & Lymphoma Society (LLS) in partnership with Weill Cornell Medical College, NewYork-Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center are presenting a patient education event on Monday, September 10 at Weill Cornell Medical College.

Click here to register or contact Judy Letvak at (212) 376-4762.

Topics:

  • General overview of lymphoma
  • Clinical Trials/Select New Therapies
  • Complementary Medicine
  • Panel Discussion/Q&A

Moderators:

John Leonard, MD and Andrew D. Zelenetz, MD, PhD

Speakers:

Peter Martin, MD
Jia Ruan, MD
Gary Deng, MD, PhD

Date and Time:

Monday, September 10, 2012, 6:00 pm to 8:00 pm

Location:

The Griffis Faculty Club at Weill Cornell Medical College
521 East 68th Street (east of York Avenue)
New York, NY 10021

A light dinner will be provided