Subject(s)
HIV Infections , HIV Seropositivity , HIV-1 , Hematopoietic Stem Cell Transplantation , Humans , Causality , Hematopoietic Stem Cell Transplantation/methods , Remission Induction , Transplantation Conditioning , Transplantation, Homologous , Treatment Outcome , HIV Infections/therapy , HIV Infections/virologyABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Management of pan-resistant cytomegalovirus infection (CMVi) requires a multifaceted approach, including host defence optimization by reducing immunosuppression, and standard or experimental antiviral therapy. CASE DESCRIPTION: A 36-year-old man with anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma, who underwent allogeneic haematopoietic stem cell transplant (alloHCT) with resultant graft-versus-host disease treated with immunosuppressive therapy, developed pan-resistant CMVi. He was successfully treated with combination therapy of maribavir and letermovir. WHAT IS NEW AND CONCLUSION: Combination therapy, used for other infections to prevent cross-resistant, may apply for CMVi.
Subject(s)
Cytomegalovirus Infections , Hematologic Neoplasms , Hematopoietic Stem Cell Transplantation , Acetates , Adult , Antiviral Agents/therapeutic use , Benzimidazoles , Cytomegalovirus , Cytomegalovirus Infections/drug therapy , Hematologic Neoplasms/complications , Hematologic Neoplasms/drug therapy , Humans , Male , Quinazolines , RibonucleosidesABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Treatment for diffuse large B-cell lymphoma (DLBCL) in persons with AIDS consists of chemotherapy alongside antiretroviral therapy (ART). To determine optimal HIV treatment, drug-drug interactions, toxic effects and ART resistance must be considered. CASE DESCRIPTION: A 40-year-old man with drug-resistant HIV and DLBCL initiating chemotherapy which had drug interactions with his ART. During chemotherapy, darunavir/cobicistat was held and ibalizumab-uiyk was started to ensure he was on three active HIV medications. WHAT IS NEW AND CONCLUSION: Ibalizumab-uiyk has no known drug-drug interactions and may be used as bridge therapy for patients with drug-resistant HIV undergoing chemotherapy.
Subject(s)
Anti-HIV Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , HIV Infections/complications , HIV Infections/drug therapy , Lymphoma, Large B-Cell, Diffuse/complications , Adult , Antineoplastic Agents/therapeutic use , Drug Interactions , Drug Resistance, Viral , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , MaleABSTRACT
PURPOSE: Primary objective is to evaluate safety of isavuconazonium sulfate (ISA) in pediatrics below 18 years old. Exploratory endpoint includes mortality due to probable and proven invasive fungal infection (IFI) and overall morality in this population. PATIENTS AND METHODS: Retrospective review of patients below 18 years receiving ISA for ≥7 days for possible, probable, or proven IFI or prophylaxis between June 2015 and March 2018. Descriptive analysis performed to calculate median, frequency, and percentages. RESULTS: Safety analysis included 18 patients and a subgroup of 11/18 patients were assessed for efficacy. Median age 12.5 years (4 to 17 y), median weight 50.25 kg (19 to 118 kg), 50% male, 77% acute leukemias, 94% hematopoietic cell transplant recipients, 50% matched unrelated donors and 78% in remission. Elevated alanine aminotransferase 3 times baseline within 30 days of ISA occurred in 22% (4/18). No patients had elevated bilirubin or increase in serum creatinine. All-cause mortality at 90 days was 22% (4/18) and 27% (3/11) in patients with probable or proven IFI. Clinical response rates: 14-day: 45% (5/11) partial, 27% (3/11) stable; 30-day: 45% (5/11) partial, 36% (4/11) stable; 90-day: 54% (6/11) had either partial (n=3) or complete (n=3) response to ISA. CONCLUSIONS: ISA is safe in pediatric patients for the treatment of IFI. Prospective, randomized controlled trials are warranted to determine efficacy and safety of ISA in pediatric patients with hematologic malignancies and hematopoietic cell transplant.
