Incidence, prevention and management of severe infections in patients undergoing therapy for chronic lymphocytic leukemia

Introduction: Chronic Lymphocytic Leukemia (CLL) is a disease marked by high infectious risk due to a combination of patient, disease and treatment-related factors. As a new landscape in the therapeutic panorama is emerging with the introduction of novel agents, it is essential to understand their impact on the incidence of infectious events and consequently what prevention and management strategies should be introduced. Areas covered: We searched the PUBMED database considering peer-reviewed papers published between January 2013 and January 2025 that reported on at least 100 patients and provided detailed information on infectious complications. Retrospective studies, pooled analyses, and commentaries were excluded. Expert opinion: Infections are a considerable adverse effect that can occur in CLL patients under treatment, with their incidence being influenced by intrinsic biology of the disease, the number of prior lines of therapy, and treatment duration. This being considered, the initiation of fixed duration therapy combined with the use of preventive measures, such as immunoglobulin replacement therapy and vaccination programs, should be preferred whenever feasible.