Revised Guidelines for Managing Respiratory Infections in Leukemia Patients

People with leukemia are particularly vulnerable to respiratory infections due to their compromised immune systems caused by both the disease itself and its treatments. A recent update to clinical guidelines synthesizes a decade’s worth of research, focusing on viruses that cause respiratory illnesses in these patients. This comprehensive review discusses the severity of various viruses, methods for their diagnosis, hygiene protocols, and available treatment and vaccination options.

Professor Marie von Lilienfeld-Toal of Ruhr University Bochum, Germany, led the development of these recommendations, published in The Lancet Infectious Diseases on August 27, 2025. The guidelines offer a unified approach for detecting, preventing, and managing community-acquired respiratory viral infections, including SARS-CoV-2, in individuals with hematologic malignancies and those undergoing hematopoietic cell transplantation.

Patients with blood cancers are especially susceptible to infections—even those typically considered minor by healthy individuals—such as influenza, which can be fatal in 10% of cases among immunocompromised persons. This increased risk persists for about a year following intensive treatments like stem cell transplants. The guidelines emphasize that these patients shed viruses longer and have less protection from vaccines, underscoring the importance of tailored infection control strategies.

The review analyzed extensive literature from 2014-2024 covering multiple viruses, including adenovirus, bocavirus, coronavirus, influenza, metapneumovirus, parainfluenza, respiratory syncytial virus, and rhinovirus. Strategies encompass laboratory diagnostics that include SARS-CoV-2 testing and infection prevention measures beyond COVID-19.

Special recommendations are provided for vaccinating and treating young children, with seasonal inactivated influenza vaccines and early antiviral therapies advised for influenza prevention. For respiratory syncytial virus (RSV), approved vaccines may be considered depending on regional approvals, though evidence specific to leukemia patients remains limited. Passive immunization with Palivizumab or Nirsevimab is recommended for children under two, while high-risk patients, such as those post-stem cell transplant, may also require ribavirin and intravenous immunoglobulins.

For other respiratory viruses, supportive care remains the primary intervention, focusing on immune support and minimizing steroid use. The guidelines highlight significant gaps in data regarding immunization and antiviral treatments, calling for further research.

These recommendations are crucial for healthcare providers, caregivers, and patients, as respiratory viruses often originate from the environment. Being well-informed helps ensure better infection control in outpatient settings, homes, and clinics, ultimately reducing the risk of severe respiratory illnesses in vulnerable leukemia patients.

Source: https://medicalxpress.com/news/2025-08-guideline-respiratory-infections-leukemia.html