Adjuvant and salvage therapy with leflunomide for recalcitrant cytomegalovirus infections in hematopoietic cell transplantation recipients: A case series

Antiviral Res. 2016 Nov:135:91-96. doi: 10.1016/j.antiviral.2016.08.027. Epub 2016 Sep 1.

Abstract

Cytomegalovirus (CMV) reactivation is a clinically significant complication in hematopoietic stem cell transplant (HCT) recipients. Alternative therapy for multidrug-resistant CMV is limited and often fails. Leflunomide has been used to treat resistant CMV infections, however, data on efficacy, safety, and guidance for therapeutic drug level monitoring are lacking. In this report, we describe 3 HCT recipients with multi-drug resistant CMV infections who received leflunomide as adjuvant and salvage therapy. The therapeutic effect of leflunomide as an anti-CMV agent based on virologic responses and therapeutic drug monitoring were evaluated.

Keywords: Cytomegalovirus; Drug level; Leflunomide; Resistance; Stem cell transplant.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use*
  • Chemotherapy, Adjuvant
  • Cytomegalovirus / drug effects
  • Cytomegalovirus Infections / drug therapy*
  • Drug Monitoring
  • Drug Resistance, Viral
  • Drug Therapy, Combination
  • Female
  • Foscarnet / therapeutic use
  • Ganciclovir / therapeutic use
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Isoxazoles / therapeutic use*
  • Leflunomide
  • Male
  • Middle Aged
  • Salvage Therapy
  • Transplant Recipients*
  • Virus Activation / drug effects*

Substances

  • Antiviral Agents
  • Isoxazoles
  • Foscarnet
  • Leflunomide
  • Ganciclovir