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Listeriosis in Patients with Chronic Lymphocytic Leukemia Who Were Treated with Fludarabine and Prednisone

Elias Anaissie, MD; Dimitrios P. Kontoyiannis, MD; Hagop Kantarjian, MD; Linda Elting, PhD; Lester E. Robertson, MD; and Michael Keating, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by the Infectious Disease Research Fund, Section of Infectious Disease, The University of Texas M. D. Anderson Cancer Center.

Requests for Reprints: Elias J. Anaissie, MD, Section of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 47, Houston, TX 77030.

Current Author Addresses: Drs. Anaissie, Kontoyiannis, Kantarjian, Elting, Robertson, and Keating: The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 47, Houston, TX 77030.

Ann Intern Med. 1992;117(6):466-469. doi:10.7326/0003-4819-117-6-466
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Objective: To determine whether therapy with fludarabine plus prednisone in patients with chronic lymphocytic leukemia increases the risk for developing listeriosis.

Design: Retrospective cohort study based on hospital surveillance data.

Setting: Referral cancer center.

Participants: A total of 795 patients with chronic lymphocytic leukemia who received care at The University of Texas M. D. Anderson Cancer Center between 1980 and 1990.

Interventions: Patients were treated with fludarabine alone or fludarabine and prednisone.

Measurements: The listeriosis attack rate was analyzed according to the type of treatment received.

Results: Seven of 408 patients in the fludarabine group developed listeriosis (1. 7%; 95% Cl, 0.2% to 6%) compared with 0 of 387 patients who received conventional chemotherapy alone (0% to 0.9%; P = 0.015). The 7 patients were among 248 patients who were treated with both fludarabine and prednisone; none of 160 patients treated with fludarabine alone developed listeriosis (P = 0.045 by the Fisher exact test). A dramatic reduction in CD4 counts occurred in patients after fludarabine and prednisone treatment and coincided with the development of listeriosis.

Conclusion: The administration of fludarabine plus prednisone is associated with an increased incidence of listeriosis in patients with chronic lymphocytic leukemia. The depletion of CD4 cells may underlie the pathogenesis.





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