Leflunomide therapy for refractory cytomegalovirus infections in hematopoietic stem cell transplant recipients.

Autor:	Wang E; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, USA., Jan AS; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, USA., Doan VP; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, USA., Ferguson JB; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, USA., Yeh JC; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, USA.
Jazyk:	angličtina
Zdroj:	Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners [J Oncol Pharm Pract] 2019 Oct; Vol. 25 (7), pp. 1731-1737. Date of Electronic Publication: 2018 Aug 31.
DOI:	10.1177/1078155218796188
Abstrakt:	Background: Currently, there are no prospective, randomized trials analyzing leflunomide for the treatment of cytomegalovirus infection or disease in allogeneic stem cell transplant patients. Objective: The primary objective of this case series was to determine the clinical and virological responses of utilizing leflunomide as therapy for refractory cytomegalovirus infections, unresponsive to first-line therapy in allogeneic stem cell transplant patients. Additionally, patient and leflunomide specific characteristics were identified and determined in this descriptive case series. Methods: This is a single-center, case series of adult allogeneic stem cell transplant patients with refractory cytomegalovirus infections receiving leflunomide between 1 January 2005 and 31 March 2015. Results: A total of 14 patients with refractory cytomegalovirus infections received leflunomide. All patients received concurrent anti-cytomegalovirus therapy. Nine of 13 patients tested positive for phosphotransferase UL97 and/or viral DNA polymerase UL54 genotype mutations. Nine patients achieved a virological response with undetectable cytomegalovirus titers. Of the 13 patients with teriflunomide serum levels, eight patients maintained levels >40 micrograms/milliliter (mcg/mL). Common adverse effects were pancytopenia (n = 8) and elevated liver function tests (n = 4). Conclusions: Despite current strategies, refractory or recurrent cytomegalovirus infection and disease remain a clinical challenge to treat in the stem cell transplant patient population. Leflunomide used in combination with other concomitant therapies use for refractory cytomegalovirus infection in clinical practice may be a safe and effective option in the allogeneic stem cell transplant patient population.
Databáze:	MEDLINE
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