Reactions Weekly | 2021
Multiple drugs
Abstract
Bone marrow toxicity, kidney toxicity and lack of efficacy: 3 case reports A retrospective review of four patients with inborn errors of immunity, who were treated with virus-specific T cells (VST) between January 2014 and December 2019, described three patients, aged 5–18 years [including two boys and one female patient], who exhibited a lack of efficacy during treatment with ganciclovir, valganciclovir, foscarnet, cidofovir, leflunomide, artesunate, cytomegalovirus immune globulin or rituximab for cytomegalovirus (CMV) infection or Epstein-Barr virus (EBV) infection. Additionally, two of these patients developed bone marrow toxicity or kidney toxicity during treatment with ganciclovir, foscarnet or aciclovir for CMV infection or EBV infection [not all routes stated; dosages, durations of treatments to reactions onsets and outcomes not stated]. Patient 2: The 5-year-old boy, who had congenital dyskeratosis, was diagnosed with CMV infection with clinical manifestations of pneumonitis, colitis and retinitis. He received treatment with ganciclovir, valganciclovir, foscarnet, cidofovir, leflunomide, artesunate and IV cytomegalovirus immune globulin [CMV-specific IVIG]. These drugs failed to control viraemia and the disease progressed (lack of efficacy). Additionally, he developed bone marrow toxicity due to ganciclovir and kidney toxicity due to foscarnet. Hence, he was scheduled for haematopoietic stem cell transplantation (HSCT). Prior to HSCT, he received six infusions of VST and showed partial response. Subsequently, the percentage of chimerism returned to 0. Thereafter, viral disease progressed, which led to death before HSCT could be performed. Patient 3: The 6-year-old boy, who had Rothmund-Thomson syndrome, was diagnosed with CMV infection with clinical manifestations of pneumonitis and encephalitis. He received treatment with ganciclovir, valganciclovir, foscarnet, cidofovir and IV cytomegalovirus immune globulin [CMV-specific IVIg]. These drugs failed to control viraemia and the disease progressed (lack of efficacy). Hence, he was scheduled for haematopoietic stem cell transplantation (HSCT). Prior to HSCT, he received single VST infusion and showed complete response. He received prednisolone and hydrocortisone before VST infusion. Later, viral disease progressed, which led to death before HSCT could be performed. Patient 4: An 18-year-old female patient, who had combined immunodeficiency, was diagnosed with EBV infection with clinical manifestations of chronic active Epstein-Barr virus infection and haemophagocytic lymphohistiocytosis. She received treatment with ganciclovir and rituximab. These drugs failed to control viraemia and the disease progressed (lack of efficacy). Additionally, she received aciclovir. However, she developed kidney toxicity due to aciclovir. Hence, she was scheduled for haematopoietic stem cell transplantation (HSCT). Prior to HSCT, she received two infusions of VST and showed partial response. She received prednisone, fludarabine and cyclophosphamide before VST infusions. Later, viral disease progressed, which led to death before HSCT could be performed.