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EBMT 2021 | Infections in patients receiving brentuximab vedotin or BTK inhibitors

Livio Pagano, MD, Catholic University of Sacred Heart, Rome, Italy, discusses the results of a retrospective study analyzing the incidence and characteristics of fungal infections in patients with lymphoproliferative disorders, who are treated with brentuximab vedotin. The study, conducted by the SEIFEM group (Epidemiological Surveillance of Infections in Hematological Diseases), reported that treatment with brentuximab vedotin did not increase the risk of fungal infection. Prof. Pagano also discusses the risk and challenges of fungal infections in patients with chronic lymphocytic leukemia (CLL) who are receiving ibrutinib, acalabrutinib, or other Bruton’s tyrosine kinase (BTK) inhibitors. BTK inhibitors impact macrophages, subsequently increasing the risk of fungal infections. Administration of prophylaxis in this group of patients is challenging due to the long-term nature of treatment. This interview took place during the 47th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2021.

Transcript (edited for clarity)

Brentuximab is mainly used utilized in Hodgkin lymphoma. And we analyze it in my group, in SEIFEM group, also the risk of infection, of a fungal infection during the treatment with brentuximab. And sincerely, we not see a, an increase of risk with this drug. That is lower with the respect the other drugs that we usually use, is not a risk. And also, we can at least in these kind of patients, all the drugs, antifungal drugs are in this position because there is no interaction...

Brentuximab is mainly used utilized in Hodgkin lymphoma. And we analyze it in my group, in SEIFEM group, also the risk of infection, of a fungal infection during the treatment with brentuximab. And sincerely, we not see a, an increase of risk with this drug. That is lower with the respect the other drugs that we usually use, is not a risk. And also, we can at least in these kind of patients, all the drugs, antifungal drugs are in this position because there is no interaction. So, low-risk and the possibility to treat better these kind of patients. So for this subset of patients I not see relevant problem, okay?

A different situation probably is for ibrutinib, but for chronic lymphocytic leukemia, because Bruton kinase inhibitors, not only ibrutinib, but also the next, acalabrutinib, and the others that will arrive in the next months have an important role, because they not only destroy the damaged or the lymphocytic cells, the lymphoma cells, but also an action against macrophage, and reducing the activity of macrophage, reducing the activity of the organism, and yes, the fungi that could be present in the organism.

So, there is the possibility of increase of fungal infections in these kind of patients which is the problem. The problem is that the people that receive these kind of drugs are too much and give to all an antifungal prophylaxis is not possible. So much expensive, we must understand how many patient’s needs, specific group that probably needs a prophylaxis. And how long will this prophylaxis? Because the treatment for chronic lymphocytic leukemia is not as for acute leukemia. Brief and strong, but is it long when they have two years?

So, it’s crazy to think to give this to these patients, a prophylaxis for two years. The antifungal prophylaxis are reduced its efficacy and there is the risk of resistance. And so, we must understand with epidemiological side, of course, to whom and for how many times give them the prophylaxis?

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Disclosures

Prof. Livio Pagano, MD, discloses connections to Jazz Pharmaceuticals, Janssen, Novartis, Gilead, Menarini, Cidara Therapeutics, Stemline, Pfizer and MSD.

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