Prophylaxis for patients treated with purine analogues

The purine analogues fludarabine and 2-CDA used in standard lympho-proliferative protocols induce neutropenia in all cases. Nadir ~14d post-treatment initiation and neutrophil counts may fall to zero for several days or even weeks. They are therefore associated with the usual neutropenic infections. In addition, purine analogues have a particular property of inhibition of T4 helper lymphocyte subsets within weeks of initiation of therapy (nadir at 3 months) and may last for >1 year following cessation of therapy. This profound T4 function inhibition predisposes to fungal infection, as well as a higher incidence of Herpes zoster infection and PCP. I lymphocyte function also predisposes to transfusion associated GvHD in passenger lymphocytes of donor blood transfusions.

0 0

Post a comment