Use of leflunomide in an allogeneic bone marrow transplant recipient with refractory cytomegalovirus infection
| Autor: | Matt Kalaycio, Sherif B. Mossad, Brian J. Bolwell, Julie Curtis, W J Waldman, Alan J. Taege, J R Long, J W Williams, Robin K. Avery, David L. Longworth, Brad Pohlman, Belinda Yen-Lieberman, Debra Kohn, Nell S. Lurain |
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| Rok vydání: | 2004 |
| Předmět: |
Ganciclovir
Foscarnet medicine.medical_treatment Graft vs Host Disease chemistry.chemical_compound Fatal Outcome Leukemia Myelogenous Chronic BCR-ABL Positive Drug Resistance Viral medicine Humans Transplantation Homologous Bone Marrow Transplantation Leflunomide Salvage Therapy Transplantation business.industry virus diseases Isoxazoles Hematology Middle Aged Viral Load biochemical phenomena metabolism and nutrition medicine.disease Immunosuppressive drug Graft-versus-host disease chemistry Cytomegalovirus Infections Immunology Drug Therapy Combination Female business Viral load Immunosuppressive Agents Liver Failure medicine.drug Cidofovir |
| Zdroj: | Bone Marrow Transplantation. 34:1071-1075 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1704694 |
| Popis: | Ganciclovir-resistant cytomegalovirus (CMV) infection is an emerging problem in transplant recipients. Foscarnet resistance and cidofovir resistance have also been described, but no previous reports have suggested treatment regimens for patients with CMV refractory to all three of these drugs. Leflunomide, an immunosuppressive drug used in rheumatoid arthritis and in rejection in solid-organ transplantation, has been reported to have novel anti-CMV activity. However, its clinical utility in CMV treatment has not been described previously. We report an allogeneic bone marrow transplant recipient who developed CMV infection refractory to sequential therapy with ganciclovir, foscarnet, and cidofovir. The patient was ultimately treated with a combination of leflunomide and foscarnet. Both phenotypic and genotypic virologic analysis was performed on sequential CMV isolates. The patient's high CMV-DNA viral load became undetectable on leflunomide and foscarnet, but the patient, who had severe graft-versus-host disease (GVHD) of the liver, expired with progressive liver failure and other complications. We concluded that leflunomide is a new immunosuppressive agent with anti-CMV activity, which may be useful in the treatment of multiresistant CMV. However, the toxicity profile of leflunomide in patients with underlying GVHD remains to be defined. |
| Databáze: | OpenAIRE |
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