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

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
Emily WangJason C Yeh

Abstract

Currently, there are no prospective, randomized trials analyzing leflunomide for the treatment of cytomegalovirus infection or disease in allogeneic stem cell transplant patients. 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. 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. 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 adver...Continue Reading

References

Mar 24, 2005·The New England Journal of Medicine·James W WilliamsMichelle A Josephson
Mar 21, 2009·Blood·Michael Boeckh, Per Ljungman
Aug 5, 2010·Transplantation·Robin K AveryBelinda Yen-Lieberman
Nov 19, 2011·Transplant Infectious Disease : an Official Journal of the Transplantation Society·B Chacko, G T John
Sep 18, 2013·Cancer Letters·Ella J Ariza-HerediaRoy F Chemaly
Dec 3, 2014·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Michael BoeckhKarl S Peggs
Oct 30, 2016·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Per LjungmanUNKNOWN Disease Definitions Working Group of the Cytomegalovirus Drug Development Forum

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Methods Mentioned

BETA
phosphotransferase
PCR

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