EBMT 2021 | Impact of novel therapies on post-transplant infection risk

Livio Pagano, MD, Catholic University of Sacred Heart, Rome, Italy, summarizes his talk on the impact of the new hematological treatment landscape and the risk of invasive fungal infections after transplantation. Prof. Pagano describes how novel therapies for the treatment of patients with acute myeloid leukemia (AML) may increase the risk of post-transplant fungal infections, or make treatment of these infections challenging. For example, the FLT3 inhibitor midostaurin interacts with the CYP3A4 co-enzyme, which is a substrate that is important for anti-fungal prophylaxis. The BCL-2 inhibitor venetoclax can interact with azoles, resulting in cardiac toxicity and severe neutropenia. Treatment with the CD33-targeting monoclonal antibody gemtuzumab ozogamicin increases immunosuppression, with a resulting increase in risk of fungal infection, and the cytarabine-daunorubicin liposome (CPX-351), which is primarily used to treat secondary AML, can cause prolonged neutropenia which is associated with high fungal infection rates. Prof. Pagano also describes how the increased risk of fungal infection impacts outcomes for patients receiving transplantation. This interview took place during the 47th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2021.