372
Use of Leflunomide in the Treatment of Recalcitrant CMV Infection in Immunocompromised Patients
Poster Abstracts
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Nobuyoshi Mori, MD
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Jakapat Vanichanan, MD
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Dimpy P Shah, MD, MSPH
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Frank Tverdek, Pharm D
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Jean Tayar, MD
,
Department of Rheumatology, The University of Texas MD Anderson Cancer Center, Houston, TX
Ella Ariza-Heredia, MD
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Victor E Mulanovich, MD
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Roy F Chemaly, MD, MPH, FIDSA, FACP
,
Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Background. CMV infection resistant or refractory to the standard antiviral therapy constitutes a major threat to immunocompromised patients, especially leukemia or hematopoietic stem cell transplant (HSCT) patients. In addition, treatment of CMV recurrences may lead to myelosuppression or renal insufficiency due to adverse effects of ganciclovir derivatives or foscarnet. Leflunomide, a drug originally approved for rheumatoid arthritis, has been reported to have anti-CMV activity. We report our experience with leflunomide therapy in patients with recalcitrant CMV infection.
Methods. A Single center, retrospective study of 4 patients following HSCT and 1 patient with leukemia. Clinical data were extracted from the electronic medical record. CMV antigenemia (CMV-Ag) was performed for diagnosis of CMV reactivation.
Results. After genotypic analysis, 2 isolates had UL97 and UL54 mutations, 1 had UL97, 1 showed no mutations, and in 1 isolate, genotyping was not performed. Interestingly, 4 of 5 patients had no end-organ diseases, while 1 had CMV pneumonitis. Leflunomide was used in combination with ganciclovir derivatives or foscarnet in 4 patients, while it was used alone in 1. Leflunomide at an average dose of 30mg/day was initiated at mean CMV Ag of 2078 cells (range: 194-6888) and serum level was around 30 mcg/mL in most of the patients. Complete clearance of CMV Ag was observed in 4 patients and the mean duration from start of leflunomide to clearance was 40 days (26-73 d) and no one progressed to end-organ disease. The remaining patient with CMV pneumonitis expired with respiratory failure before CMV Ag was cleared, however, CMV Ag dropped from 2592 to 47 cells at 36 days after initiation of leflunomide. No adverse events related to leflunomide use were observed.
Conclusion. Leflunomide, alone or in combination with ganciclovir derivatives or foscarnet, could be a useful alternative therapy of resistant or refractory CMV reactivation although time to response is prolonged. Its usefulness in patients with end-organ disease still needs to be determined.
Disclosures:
Nothing To Disclose
