Giving Compass' Take:

• Sabin Russell shares five key takeaways from Fred Hutch's 3rd Symposium on Infectious Diseases in the Immunocompromised Host.

• How can funders best support the needs of immune-compromised patients? What research is still needed?

• Learn about fighting antimicrobial resistance with a One Health approach.

1. Changing cancer therapies
The emergence of certain cancer treatments involving genetically modified immune cells — called CAR T-cell therapies — has brought with it a slate of questions about how an immune system re-engineered to fight cancer can cope with its normal defensive chores of guarding against infection. Hutch researcher Dr. Josh Hill noted that several studies have shown that patients who suffer the feverish “cytokine-release syndrome” as the newly engineered cells proliferate and attack their cancer are also the most vulnerable to infections after treatment. The more severe the syndrome, the greater the likelihood of subsequent infection.

2. New antimicrobial drugs
Since the early days of bone marrow transplantation, cytomegalovirus, a member of the herpes family, has been a major killer of immune-compromised patients. In November 2017, just a few months after the previous Hutch symposium was held in Seattle, the U.S. Food and Drug Administration approved letermovir, a new antiviral targeting CMV infection in transplant patients.

3. The microbiome is important
The gut microbiome, the community of bacteria, viruses and fungi that inhabit our colon, is increasingly recognized as a critical factor in how the human immune system responds to hostile microbes. A session focused on infection by Clostridium difficile, a bacterium that causes diarrhea and inflammation of the colon in almost 500,000 patients a year in the U.S. and kills 29,000 of them. It afflicts those, such as transplant patients, who have taken heavy courses of antibiotics. Fred Hutch’s Dr. David Fredricks said the symposium highlighted “the important connection between the gut microbiome and susceptibility to this infection.”

4. Better diagnostics are coming
Essential for controlling infectious disease is accurate and early identification of the organisms that may cause it. If a test can identify the threat as a virus, rather than a bacterium, doctors will know they can stop giving antibiotics, which are useless against viruses and carry a wide range of side effects — such as killing helpful bacteria in the gut microbiome.

5. We need to protect our antibiotics
As Woods noted in his talk, as many as half the antibiotics prescribed to patients are not needed. Improper use of antibiotics can promote the growth of antibiotic-resistant bacteria, which are responsible for 23,000 deaths in the U.S., he said. This is of concern to transplant physicians, who prescribe lots of antibiotics and for whose patients the right antibiotic may be the difference between survival or death.

Read the full article about infections in immune-compromised patients by Sabin Russell at Fred Hutchinson Cancer Research Center.