Successful Treatment of Severe Aspergillosis with Isavuconazole Therapy after Allogeneic Stem Cell Transplantation

Chemotherapy. 2019;64(2):57-61. doi: 10.1159/000502279. Epub 2019 Sep 4.

Abstract

Invasive fungal infections are one of the main infectious complications in allogeneic stem cell transplantation (SCT). Triazoles (voriconazole, posaconazole) are the main prophylactic and therapeutic options for the treatment of invasive aspergillosis. However, pharmacological interactions and hepatotoxicity limit its use. Isavuconazole (ISV) is a recently approved azole with a promising interaction and safety profile. We present a case with invasive aspergillosis in the post-allogeneic SCT setting in a critically ill patient with severe multiorgan failure due to veno-occlusive disease. The patient was treated with ISV and B amphotericin during severe kidney and liver failure and multiple immunosuppressants, without significant drug-related toxicity and with favorable outcome. The interaction and safety profile of ISV is discussed along the reported experience. ISV can be an effective salvage therapy even in complex clinical situations with multiple potential interactions.

Keywords: Antifungal agents; Antifungals; Aspergillosis; Interaction; Isavuconazole; Stem cell transplantation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use*
  • Aspergillosis / drug therapy
  • Aspergillosis / therapy*
  • Aspergillus fumigatus / genetics
  • Aspergillus fumigatus / isolation & purification
  • DNA, Fungal / metabolism
  • Graft vs Host Disease / etiology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Male
  • Nitriles / therapeutic use*
  • Pyridines / therapeutic use*
  • Thorax / diagnostic imaging
  • Transplantation, Homologous / adverse effects
  • Triazoles / therapeutic use*

Substances

  • Antifungal Agents
  • DNA, Fungal
  • Nitriles
  • Pyridines
  • Triazoles
  • isavuconazole