Immunosuppressants

Immunosuppressants Reactions 1680, p170 - 2 Dec 2017 Disseminated coccidioidomycosis: case report A 65-year-old man developed disseminated coccidioidomycosis following immunosuppresive therapy with carmustine [BCNU], cyclophosphamide, doxorubicin, vincristine, ifosfamide, carboplatin, cytarabine [Ara-C], etoposide, fludarabine, methotrexate, prednisone and rituximab [routes not stated; not all dosages stated]. The man was diagnosed with stage IVA composite follicular lymphoma/diffuse large B-cell lymphoma in September 2008. Subsequently, he received eight cycles of R-CHOP chemotherapy, which consisted of rituximab, prednisone, cyclophosphamide, doxorubicin and vincristine. The chemotherapy resulted in first complete remission (CR) in 2009. However, due to disease relapse December 2009, he received three cycles of salvage rituximab, etoposide, ifosfamide and carboplatin, which was followed by radiation therapy. In March 2010, he underwent a high-dose consolidation with auto-haematopoietic stem cell transplant (HSCT) rescue using conditioning regimen with combination carmustine, cyclophosphamide, etoposide and cytarabine. In October 2010, the disease relapsed once again. He was treated with rituximab [Rituxan], cytarabine and methotrexate in December 2010. In February 2011, he underwent an allo- HSCT using conditioning with rituximab and total body irradiation. In August 2011, he achieved CR for the third time. However, he developed skin and oral chronic graft versus host disease (GVHD). In February 2012, the disease relapsed again, and he also experienced a flare of skin and oral chronic GVHD. Both, chronic GVHD and relapse were treated with prednisone and rituximab four doses weekly. In August 2015, he was enrolled in a clinical trial for treatment with CD19 directed CAR T-cells (off label therapy for the treatment of NHL). He underwent apheresis for T-cell collection. He received preparatory three day cytoreductive chemotherapy with fludarabine 25 mg/m and lymphodepleting cyclophosphamide [Cytoxan] 60 mg/kg. Thereafter, in December 2015, a fine needle aspiration demonstrated spherules, indicating disseminated coccidioidomycosis. Prolonged history of immunosuppresive therapy and the use of CD20 targeting antibody rituximab, were considered possible risk factors for the disseminated coccidioidomycosis. Hence, the man was treated with fluconazole. In February 2016, a repeat PET showed resolving infectious/ inflammatory process. In July 2017, his bronchoscopy and fine needle aspiration of lymph node revealed recurrence of disseminated coccidioidomycosis. As of August 2017, he was on re-treatment for disseminated coccidioidomycosis [outcome not stated]. Author comment: "[P]ossible risk factors in this case include . . . history of immunosuppressive therapy with allo- HSCT, chronic GVHD and prior therapies like the use of CD20 targeting antibody Rituximab." Zahid U, et al. Coccidioidomycosis, immunoglobulin deficiency: Safety challenges with CAR T cells therapy for relapsed lymphoma. Immunotherapy 9: 1061-1066, No. 13, Oct 2017. Available from: URL: http://doi.org/10.2217/imt-2017-0070 - USA 803284427 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Immunosuppressants

Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
Free
1 page
Loading next page...
1 Page
 
/lp/springer_journal/immunosuppressants-i5zHc9yWBG
Publisher
Springer International Publishing
Copyright
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-017-39101-9
Publisher site
See Article on Publisher Site

Abstract

Reactions 1680, p170 - 2 Dec 2017 Disseminated coccidioidomycosis: case report A 65-year-old man developed disseminated coccidioidomycosis following immunosuppresive therapy with carmustine [BCNU], cyclophosphamide, doxorubicin, vincristine, ifosfamide, carboplatin, cytarabine [Ara-C], etoposide, fludarabine, methotrexate, prednisone and rituximab [routes not stated; not all dosages stated]. The man was diagnosed with stage IVA composite follicular lymphoma/diffuse large B-cell lymphoma in September 2008. Subsequently, he received eight cycles of R-CHOP chemotherapy, which consisted of rituximab, prednisone, cyclophosphamide, doxorubicin and vincristine. The chemotherapy resulted in first complete remission (CR) in 2009. However, due to disease relapse December 2009, he received three cycles of salvage rituximab, etoposide, ifosfamide and carboplatin, which was followed by radiation therapy. In March 2010, he underwent a high-dose consolidation with auto-haematopoietic stem cell transplant (HSCT) rescue using conditioning regimen with combination carmustine, cyclophosphamide, etoposide and cytarabine. In October 2010, the disease relapsed once again. He was treated with rituximab [Rituxan], cytarabine and methotrexate in December 2010. In February 2011, he underwent an allo- HSCT using conditioning with rituximab and total body irradiation. In August 2011, he achieved CR for the third time. However, he developed skin and oral chronic graft versus host disease (GVHD). In February 2012, the disease relapsed again, and he also experienced a flare of skin and oral chronic GVHD. Both, chronic GVHD and relapse were treated with prednisone and rituximab four doses weekly. In August 2015, he was enrolled in a clinical trial for treatment with CD19 directed CAR T-cells (off label therapy for the treatment of NHL). He underwent apheresis for T-cell collection. He received preparatory three day cytoreductive chemotherapy with fludarabine 25 mg/m and lymphodepleting cyclophosphamide [Cytoxan] 60 mg/kg. Thereafter, in December 2015, a fine needle aspiration demonstrated spherules, indicating disseminated coccidioidomycosis. Prolonged history of immunosuppresive therapy and the use of CD20 targeting antibody rituximab, were considered possible risk factors for the disseminated coccidioidomycosis. Hence, the man was treated with fluconazole. In February 2016, a repeat PET showed resolving infectious/ inflammatory process. In July 2017, his bronchoscopy and fine needle aspiration of lymph node revealed recurrence of disseminated coccidioidomycosis. As of August 2017, he was on re-treatment for disseminated coccidioidomycosis [outcome not stated]. Author comment: "[P]ossible risk factors in this case include . . . history of immunosuppressive therapy with allo- HSCT, chronic GVHD and prior therapies like the use of CD20 targeting antibody Rituximab." Zahid U, et al. Coccidioidomycosis, immunoglobulin deficiency: Safety challenges with CAR T cells therapy for relapsed lymphoma. Immunotherapy 9: 1061-1066, No. 13, Oct 2017. Available from: URL: http://doi.org/10.2217/imt-2017-0070 - USA 803284427 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680

Journal

Reactions WeeklySpringer Journals

Published: Dec 2, 2017

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve Freelancer

DeepDyve Pro

Price
FREE
$49/month

$360/year
Save searches from
Google Scholar,
PubMed
Create lists to
organize your research
Export lists, citations
Read DeepDyve articles
Abstract access only
Unlimited access to over
18 million full-text articles
Print
20 pages/month
PDF Discount
20% off