Description:
The hematologist uses immunosuppressive treatments (steroids, rituximab, eculizumab, cytoxan and others) and splenectomy in the management of non-malignant hematologic disorders - immune thrombocytopenia purpura (ITP), thrombotic thrombocytopenia purpura (TTP), autoimmune hemolytic anemia (AIHA, antiphospholipid antibody syndrome (APS), acquired factor deficiencies, paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS) that put patients at risk for bacterial and viral infections or viral reactivation. Similarly, the natural course of hemogoblinopathies can lead to autosplenectomy and an increased risk for potentially life-threatening infections. The risk for infections can be minimized by applying appropriate immunizations strategies and using prophylactic antibiotics and antivirals in appropriate patients. Familiarity with existing immunization and prophylactic treatment strategies is key to prescribe the immunosuppressive therapies as safely as possible. This session with will present clinical-practical issues, with each talk discussing (a) the type of infections that occur with the various immunosuppressive treatments, (b) appropriate immunization strategies (vaccine choices, boosters, vaccine response monitoring), and (c) prophylactic use of antibiotics and antivirals.

Dr. Grace Lee will discuss the risk and type of infections that may occur after surgical splenectomy and autosplenectomy when treating non-malignant hematologic disorders. She will address appropriate immunization strategies - vaccine choices, need for booster vaccinations, need for vaccine response monitoring -, as well as whether anti-microbials should be given prophylactically to certain patients. Existing immunizations guidelines for the Centers for Disease Control (CDC) and other national agencies and societies will be hihglighted.

Dr. Luis E. Malpica will discuss the current evidence base detailing the risk of infections in patients with non-malignant immune-mediated hematologic diseases treated with corticosteroids and/or other oral immunosuppressants (e.g. antimetabolite, calcineurin inhibitor, cyclophosphamide). Using a case-based approach, Dr. Malpica will outline the different preventive strategies used to mitigate infectious complications such as laboratory screening, immunization, and antimicrobial prophylaxis. In addition, management suggestions will be discussed where no formal guidelines exist.

Dr. Jolan Walter will discuss infection risk, immunization recommendations, and antimicrobial prophylaxis needs when treating patient with rituximab or eculizumab. She will address the infectious risks with these treatments, appropriate immunization strategies (vaccine choices, boosters, vaccine response monitoring), the management of the patient who needs rituximab who has positive hepatitis serologies and is at risk for viral hepatitis reactivation, the risk of infection with rituximab-induced neutropenia and whether GCSF has a benefit in this situation, and whether rituximab-associated hypogammaglobulinemia should be treated with IVIG.