Peculiarities of pneumonia in patients with chronic lymphocytic leukemia

Along with a pronounced secondary immunodeficiency, the identified morphological and functional changes contribute to the development of infectious complications of the bronchopulmonary system in patients with CLL.

Pneumonia in CLL deserves special attention, since they are the most serious complication that plays a major role in the outcome of the disease. Of the 95 people who died in 54 people (56.4%), pneumonia was the immediate cause of death. Of the 228 patients examined, CLL pneumonia was registered in 103 patients (45%). The incidence of pneumonia depended on the severity of the tumor process. A large incidence was noted in patients of group III (58 patients), less often in patients of groups II and I (36 and 9 people, respectively). Relapses of pneumonia were recorded in 16 patients in the II and in 45 patients in the III group. A total of 103 patients with CLL had 150 cases of pneumonia.

Predominantly affected lower lobes of both lungs. In most cases, pneumonia began as focal, but often there was a tendency for rapid expansion, the emergence of new pneumonic foci, often merging with each other. Lobar pneumonia was diagnosed in 14 cases (9.3%).

Nosocomial pneumonia (NP) occurred at different times in 40 CLL patients (39% of the total number who had pneumonia). Of the 150 cases of pneumonia, 54 (36%) began in the inpatient unit. In patients with a benign course of CLL, NP was not registered. In group II, NPs were noted in 13 patients, in group III, in 31 people.

An analysis of the causes of NP showed that in most cases they developed after a course of cytostatic therapy, especially after polychemotherapy, against a background of a significant decrease in the number of leukocytes. Course treatment with cyclophosphamide, chlorambucil and monotherapy with fludarabine rarely preceded the occurrence of pneumonia (4, 1 and 3 cases, respectively). More often, this was facilitated by treatment with fludarabine in combination with rituximab (FCR) (6 cases) and mitoxantrone (FCM) (8 cases). The combination of fludarabine with cyclophosphamide preceded the appearance of NP in 4 cases. The course of polychemotherapy according to the protocols CP, COP, CHOP, CAP preceded the occurrence of NP in 24 cases. In four cases, NPs developed after local radiation therapy, against the background of a sharp decrease in the number of leukocytes.At the same time, according to these statistics, one can only indirectly judge the impact of certain protocols. chemotherapy for the occurrence of infections in patients with CLL. We have been actively using treatment with fludarabine for the past few years. In the 90s of the past century, patients with CLL were treated with cyclophosphamide, chlorambucil, CP, COP, CHOP, CAP polychemotherapy courses, according to these protocols, more patients were treated. Polychemotherapy courses are conducted in most cases in patients with rapidly progressive CLL. In these patients, immunodeficiency is more pronounced, which also contributes to the occurrence of inflammatory processes in the lungs. In addition, the occurrence of pneumonia contributes to comorbidities: diabetes mellitus, COPD, coronary heart disease, arterial hypertension, etc.

Emergence of community-acquired pneumonia was preceded by influenza, ARVI, acute bronchitis, exacerbation of chronic infections of the upper respiratory tract. The causative agent in most cases was pneumococcus. In 12 patients with community-acquired pneumonia, a combined flora was sown. In 45 cases, it was not possible to establish the etiological diagnosis of pneumonia, despite the use of modern methods of laboratory diagnostics.

Gram-negative flora is 56% of pathogens NP and 23.6% of community-acquired pneumonia.

Speaking about the laboratory manifestations of pneumonia in CLL, it should be noted that due to the nature of the disease (leukocytosis, absolute lymphocytosis) in the peripheral blood tests, these patients do not have a neutrophilic shift in the leukocyte formula. The lack of neutrophils in CLL patients explains the absence or doubtful radiological data in 10 patients, since a dense inflammatory focus is not always formed, giving a clear physical and X-ray picture. In 10 patients, a lesion in the lung was detected only with computer tomography. Neutrophil deficiency is an important cause of atypical pneumonia in patients with granulocytopenia.

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