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

Abstract

▪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.