Thursday, September 25, 2014

Challenges in treating immunocompromised patients

One of the many challenges in treating immunocompromised patient is the lack of predictive bio-markers that help guide treatments of these patients while they are undergoing chemotherapy or any other immunocompromising treatment. In most cases, the treatment is reactive that is we wait until the patient is sick and proceed on to catch up by giving him a combination of Antibiotics, anti-fungals, and other available anti-virals.
We know the patients have either a cellular deficiency or an humoral dysfunction linked to the primary hematologic disease or to treatment.   But we still can't predict what if any infection will be developed.  Perturbation of the integrity of the Gastro-intestinal or pulmonary membranes that could be induced by our therapeutic interventions, and dormant viral (CMV, HH-6,)and bacterial infections (Syphilis,Tuberculosis), all could contribute to an infection outbreak, but no predictive bio-markers are available for current clinical use!
The longer the patient remains neutropenic also impact on what infection can set in!  Briefly, we have no predictive definite Biomarkers to predict what infection will be developed, and in specific cases, in patient undergoing treatment preventive or otherwise.    Ongoing treatment on Tacrolimus or Cyclosporine must be monitored with specific biomarkers that will allow closer monitoring of these patients.  Current medical practice does not allow clear measurement indicators predicting what will happen to the patients.
Another component of these issues, is predicting who will develop a sweet syndrome in our neutropenic patients, and who are susceptible to other rare event such as the PRES (posterior reversible Encephalopathy Syndrome).   Genetic Bio-markers must be out there, our point is just to go get them to declare our readiness for future medicine....
Post a Comment