Cytomegalovirus (CMV) treatment with leflunomide is safe and effective among patients who have undergone allogeneic hematopoietic stem cell transplant (allo-HSCT), though prospective studies are needed to confirm this finding, according to a retrospective poster presented at the 2017 Hematology/Oncology Pharmacy Association Annual Conference.1
Many patients who undergo allo-HSCT experience refractory or recurrent CMV infection despite CMV prophylaxis or pre-emptive treatment. The purpose of this study was to evaluate the role of the antiviral agent leflunomide in this population.
This single-center, retrospective analysis included 14 adult patients with refractory CMV infection who underwent all-HSCT between 2005 and 2015. Most patients received a loading dose of 100 mg for 3 days, followed by a maintenance dose of 20 mg per day. The final leflunomide dose ranged from 20 mg to 120 mg per day.
In the study, 9 patients demonstrated an end of treatment CMV cells/million white blood cells of 0. The data for 1 patient were not available, the remaining patients had end of treatment CMV values of 215 and 2130 cells per million white blood cells.
The most common adverse effects included cytopenia and elevated liver enzymes.
The findings of this small study suggest that leflunomide may be an effective treatment of CMV infection among patients who have received allo-HSCT. The authors wrote that “future prospective, randomized trials are needed to confirm these benefits and determine the appropriate dosing schema.”
- Jan A, Wang E, Doan V, Ferguson J, Yeh J. Leflunomide for cytomegalovirus infection in stem cell transplant recipients. Poster presented at: 13th Hematology/Oncology Pharmacy Association Annual Conference; March 29-April 1, 2017; Anaheim, CA.
This article originally appeared on Cancer Therapy Advisor