Refractory cytomegalovirus infection successfully treated after stem cell transplant

08-17-2006

Foscarnet plus leflunomide successfully treats refractory cytomegalovirus infection following stem cell transplantation.

According to a recent report from Germany, "Treatment of cytomegalovirus (CMV) disease after allogeneic hematopoietic stem cell transplantation (HSCT) is limited by toxicities of current antiviral drugs and the occurrence of drug resistant strains.

"Leflunomide, an immunosuppressive agent used for treatment of rheumatoid arthritis, also has activity against CMV by impairing viral assembly. Here we report the control of refractory CMV disease by the combined use of foscarnet and leflunomide."

"A 1 1/2-year-old boy with juvenile myelo-monocytic leukemia (JMML) received an allogeneic HSCT with bone marrow stem cells from a mismatched, unrelated donor (MMUD, recipient and donor CMV-positive).

"CMV-reactivation 2 months post transplantation (Tx) could only be controlled by the use of cidofovir. Because of secondary graft failure," said the authors, "the boy received a second HSCT with peripheral blood stem cells (PBSC) of the same donor after overall 6 months."

K. Ehlert and colleagues at University Hospital Muenster continued, "CMV-infection was noticed 3 weeks later, associated with a considerable rise of both CMV-copy number and pp65-antigen."

"Since reinduction with cidofovir was ineffective and ganciclovir not warranted due to the history of graft failure," researchers said, "the child then received a combination of foscarnet/leflunomide, leading to a rapid decline of his CMV-copy number and to an afebrile state. Hematological, hepatic or renal toxicities were not observed."

The authors concluded, "This case report suggests that leflunomide may be of use in the management of transplant recipients with CMV-infection refractory or intolerant to conventional antiviral therapy."

Ehlert and colleagues published their study in Klinische Padiatrie (Treatment of refractory CMV-infection following hematopoietic stem cell transplantation with the combination of foscarnet and leflunomide. Klin Padiatr, 2006;218(3):180-184).

For additional information, contact K. Ehlert, University of Klin Munster, Klin Padiat Hamatol & Onkol, Albert Schweitzer Str 33, D-48129 Munster, Germany.

Publisher contact information for the journal Klinische Padiatrie is: Georg Thieme Verlag kg, Rudigerstr 14, D-70469 Stuttgart, Germany.

Keywords: Muenster, Germany, Antiviral, Antiarthritis, Foscarnet/Leflunomide, Refractory Cytomegalovirus Infection, Stem Cell Transplantation.

This article was prepared by Anti-Infectives Week editors from staff and other reports. Copyright 2006, Anti-Infectives Week via NewsRx.com.