Coadministration of isavuconazole and sirolimus in allogeneic hematopoietic stem cell transplant recipients.

IF 3.8 Q2 INFECTIOUS DISEASES
Therapeutic Advances in Infectious Disease Pub Date : 2024-09-20 eCollection Date: 2024-01-01 DOI:10.1177/20499361241252539
Francesca Farina, Andrea Acerbis, Chiara Oltolini, Matteo Chiurlo, Elisabetta Xue, Daniela Clerici, Sarah Marktel, Sara Mastaglio, Alessandro Bruno, Simona Piemontese, Elisa Diral, Giorgio Orofino, Edoardo Campodonico, Consuelo Corti, Maria Teresa Lupo Stanghellini, Paolo Scarpellini, Raffaele Dell'Acqua, Antonella Castagna, Iacopo Peccatori, Fabio Ciceri, Raffaella Greco
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引用次数: 0

Abstract

Background: Invasive fungal infections (IFIs) represent a major cause of morbidity among allogeneic hematopoietic stem cell transplantation (allo-HSCT). Isavuconazole (ISA) is a broad-spectrum triazole with favorable safety profile.

Objectives and design: Herein, we evaluate the real life coadministration of ISA and sirolimus in allo-HSCT recipients in a single-center retrospective analysis, describing clinical efficacy, safety, and therapeutic drug monitoring (TDM) of both drugs.

Methods: All consecutive allo-HSCT recipients who received the coadministration of ISA and sirolimus for at least 2 weeks between July 2017 and December 2022 were included in this retrospective analysis. TDM was longitudinally performed during treatment. IFIs were classified according to the revised European Organization for Research and Treatment of Cancer/Mycoses Study Group consensus criteria.

Results: A total of 51 recipients were included in the analysis. A total of 17 patients received ISA as continuous antifungal treatment for IFI diagnosed before transplant: one patient experienced a probable invasive pulmonary aspergillosis, and one patient switched from ISA to liposomal amphotericin B for a possible IFI. A total of 34 patients started ISA as antifungal therapy for IFI diagnosed after transplant. Sixteen of 34 were treated for a proven/probable breakthrough IFI during mold-active prophylaxis: 6/16 patients died for IFI after a median of 51 days of ISA. Eighteen of 34 started ISA as empirical therapy for a possible IFI: 15/18 patients were alive with resolution of infection after 6 weeks, 1 died for disease progression, and 2 had empirically changed antifungal therapy due to pneumonia progression. Clinical and radiological response rate was 68% after 90 days from IFI diagnosis. No toxicities related to drug-drug interaction have been registered in patients reaching concomitant therapeutic levels of ISA and sirolimus.

Conclusion: The coadministration of ISA and sirolimus was safe and feasible in this cohort, confirming favorable clinical efficacy in patients with multiple-drug coadministration.

异体造血干细胞移植受者同时服用异舒康唑和西罗莫司。
背景:侵袭性真菌感染(IFI)是异基因造血干细胞移植(allo-HSCT)发病率的主要原因。异舒康唑(ISA)是一种广谱三唑类药物,具有良好的安全性:在此,我们通过单中心回顾性分析评估了在allo-HSCT受者中联合使用ISA和西罗莫司的实际情况,描述了两种药物的临床疗效、安全性和治疗药物监测(TDM):在2017年7月至2022年12月期间,所有连续接受ISA和西罗莫司联合用药至少2周的allo-HSCT受者均纳入此次回顾性分析。治疗期间纵向进行了TDM。IFI根据修订后的欧洲癌症研究和治疗组织/霉菌病研究小组共识标准进行分类:结果:共有 51 名接受者被纳入分析。共有17名患者因移植前确诊的IFI接受了ISA作为持续抗真菌治疗:其中一名患者经历了可能的侵袭性肺曲霉菌病,一名患者因可能的IFI从ISA转为两性霉素B脂质体。共有 34 名患者在移植后确诊 IFI,开始接受 ISA 作为抗真菌治疗。34名患者中有16名在霉菌活性预防期间接受了已证实/可能的突破性IFI治疗:6/16名患者在接受中位51天的ISA治疗后死于IFI。34 例患者中有 18 例开始接受 ISA 作为可能的 IFI 的经验性治疗:其中 15/18 名患者在 6 周后感染缓解并存活,1 名患者因疾病进展而死亡,2 名患者因肺炎进展而改变了抗真菌治疗方案。自确诊 IFI 起 90 天后,临床和放射学反应率为 68%。ISA和西罗莫司同时达到治疗水平的患者未出现与药物相互作用相关的毒性反应:结论:ISA和西罗莫司联合用药在该组患者中是安全可行的,证实了联合使用多种药物的患者具有良好的临床疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
8.80%
发文量
64
审稿时长
9 weeks
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