Complications
Caused by a reduction in the number of immunocompetent lymphocytes, as well as inhibition of lymphocyte activation. Treatment with purine analogs results in an increase in early and late infections.[84][90] Although addition of filgrastim (a recombinant granulocyte colony-stimulating factor) before and after cladribine therapy increases recovery of neutropenia, it does not result in a decrease in the number of febrile days, hospitalization rate, or use of antibiotics.[84][91] Therefore, routine use of growth factors for the treatment of immunosuppression is not recommended.[82][84]
Neutropenic fever is reported in approximately 40% of HCL patients undergoing treatment with cladribine.[92] If this occurs, a thorough investigation, including blood and urine cultures, chest radiography, and empiric antibiotic therapy (according to institutional guidelines), is recommended.
Recombinant granulocyte colony-stimulating factor (G-CSF; e.g., filgrastim) might be helpful in some patients to treat neutropenia associated with cladribine treatment.[7][82] However, routine use of G-CSF is not recommended because it has not been shown to improve any meaningful health outcomes.[82][84]
Prophylaxis with trimethoprim/sulfamethoxazole and acyclovir is recommended to avoid pneumocystis infections and herpes reactivation, respectively.[7]
Patients with HCL are at increased risk for secondary malignancies. Approximately 30% of patients with long-term survival will develop secondary tumors.[93]
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