Infektionen bei Patient*innen mit Akuter Myeloischer Leukämie

Eine der häufigsten Komplikationen während der Therapie der Akuten Myeloischen Leukämie (AML) sind Infektionen. Die lange Chemotherapie-assoziierte Neutropeniephase begünstigt neben bakteriellen und viralen Infektionen insbesondere das Auftreten von Pilzinfektionen. Da Infektionen mit einer erhöhten Morbidität und Mortalität verbunden sind, spielen eine umgehende Diagnostik und Therapie sowie die medikamentöse Prophylaxe eine wichtige Rolle.

Abstract

Infections represent one of the most frequent complications during therapy of acute myeloid leukemia (AML). In addition to associated prolonged phases of neutropenia, damage to the mucosal barrier by cytotoxic agents favors infections caused by endogenous pathogens. The source often remains unknown with bacteremia being the most common evidence of infection. Infections with gram-positive bacteria predominate, however, infections with gram-negative bacteria more often lead to sepsis and death. Due to prolonged neutropenia, patients with AML are furthermore at risk for invasive fungal infections. Viruses, on the other hand, are rarely the cause of neutropenic fever. Because of the limited inflammatory response in neutropenic patients, fever is often the only sign of infection and therefore always represents a hematologic emergency. Prompt diagnosis and initiation of an adequate anti-infective therapy are critical to avoid progression to sepsis and possibly death.

Kernaussagen

• Infektionen sind aufgrund der lang andauernden Neutropeniephasen während der Induktions- und Postremissionstherapien eine häufige und oft lebensbedrohliche Komplikation.

• Neutropenisches Fieber kann das einzige Zeichen einer schweren Infektion sein und stellt daher immer einen onkologischen Notfall dar.

• Der Auslöser einer Infektion bleibt oft unklar, jedoch müssen neben bakteriellen Infektionen außerdem invasive Pilzinfektionen bei der spezifischen Diagnostik und Auswahl der antimikrobiellen Therapie berücksichtigt werden.

• Zur effektiven Infektionsprophylaxe kommen Antibiotika, Virostatika und Antimykotika zum Einsatz.

• Die Einnahme prophylaktischer Azol-Antimykotika erfordert die engmaschige Überwachung möglicher Interaktionen und in einigen Fällen die Dosisanpassung neuer molekular zielgerichteter AML-Therapeutika.

Schlüsselwörter

akute myeloische Leukämie - neutropenisches Fieber - invasive Mykose

Keywords

acute myeloid leukemia - neutropenic fever - invasive fungal disease

Publikationsverlauf

Artikel online veröffentlicht:
29. März 2023

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