Table 2.

Available strategies for infection prevention

Bacterial infection	1. No routine antibiotic prophylaxis is recommended 2. Monitor ANC, especially with BCL-2i or PI3Ki 3. Ig replacement considered if IgG levels < 400 mg/dL 400–600 mg/dL: if severe recurrent infections
Fungal infection	1. Suggested: a. Elderly patients with comorbidities b. Prolonged neutropenia (> 6 months) c. R/R CLL d. Chronic concomitant steroid therapy 2. Recommended: a. Pneumocystis jirovecii prophylaxis in patients treated with PI3Ki
Viral infection	1. Pre-treatment of HBV, HCB, HIV, HSV 1/2, VZV, and CMV 2. Treatment with PI3ki, monitor CMV viral load monthly 3. If HBV reactivation is detected, prophylaxis with entecavir or tenofovir is recommended
Vaccinations	1. Recommended vaccines: a. Seasonal influenza vaccine, preferably the high dose quadrivalent b. Pneumococcal vaccine: Pneumovax (PPSV23) followed by Prevnar (PCV13) c. Recombinant zoster vaccine two doses d. Recombinant hepatitis B vaccine three doses
SARS-COVID-2	1. Encourage patients to get vaccinated in the US with Pfizer-BioNtech or Moderna 2. If severe COVID-19 infection: Hold CLL treatment until the patient has been asymptomatic for 48 h, 14 days have elapsed from the start of the infection, and two consecutive negative RT-PCR tests

ANC absolute neutrophil count, Ig immunoglobulin, IgG immunoglobulin G, BCL-2i BCL-2 inhibitor, PI3Ki PI3K inhibitor, MG milligrams, dL deciliter, R/R CLL relapsed/refractory chronic lymphocytic leukemia, HBV hepatitis B virus, HCV hepatitis C virus, HIV human immunodeficiency virus, HSV1/2 herpes simplex virus 1 and 2, VZV varicella-zoster virus, CMV cytomegalovirus, PPSV23 pneumococcal polysaccharide vaccine, PCV13 pneumococcal 13-valent conjugate vaccine, SARS-COVID-2/COVID19 severe acute respiratory syndrome coronavirus 2