Adjuvant and salvage therapy with leflunomide for recalcitrant cytomegalovirus infections in hematopoietic cell transplantation recipients: A case series.
Cytomegalovirus (CMV) reactivation is a clinically significant complication in hematopoietic stem cell transplant (HCT) recipients. Alternative therapy for multidrug-resistant CMV is limited and often fails. Leflunomide has been used to treat resistant CMV infections, however, data on efficacy, safety, and guidance for therapeutic drug level monitoring are lacking. In this report, we describe 3 HCT recipients with multi-drug resistant CMV infections who received leflunomide as adjuvant and salvage therapy. The therapeutic effect of leflunomide as an anti-CMV agent based on virologic responses and therapeutic drug monitoring were evaluated.
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Internal Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA.
Firas
F
El Chaer
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Nobuyoshi
N
Mori
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Dimpy
D
Shah
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Nora
N
Oliver
Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Emily
E
Wang
Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Anna
A
Jan
Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Vi
V
Doan
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Frank
F
Tverdek
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jean
J
Tayar
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ella
E
Ariza-Heredia
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: rfchemaly@mdanderson.org.
Roy F
RF
Chemaly
D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D016903:Drug Monitoring; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D066027:Transplant Recipients; D014775:Virus Activation / Q000187:drug effects*
D000998:Antiviral Agents; D007555:Isoxazoles; D017245:Foscarnet; D000077339:Leflunomide; D015774:Ganciclovir
Cytomegalovirus; Drug level; Leflunomide; Resistance; Stem cell transplant