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ABSTRACT TITLE

LEFLUNOMIDE AND ARTESUNATE COMBINATION THERAPY AS A PREMPTIVE STRATEGY FOR CMV
REACTIVATION IN HAPLOIDENTICAL STEM CELL TRANSPLANT

PRESENTING AUTHOR: DR SANGEETHA K PARTHIBAN

GUIDED BY: DR NAVIN KHATTRY

INSTITUTE DETAILS: TATA MEMORIAL HOSPITAL BANGALORE MUMBAI

EMAIL ID: parthibansangeetha12@gmail.com

CELL NUMBER:9819042349

ABSTRACT

SUMMARY: 31 year old gentleman, case of AML FLT3 Positive underwent haploidentical allogenic
stem cell transplant with myeloablative conditioning regimen. He received Cyclosporine, MMF and
Endoxan as GVHD prophylaxis post transplant.

CMV Reactivation occurred on D+31 of post transplant. He was started on Oral Leflunomide as
Ganciclovir could not be given in view of low counts. As the CMV titres continued to rise he was
added on Injectable Artesunate on D+49. His CMV titres reduced by 1 log on D+56 and by 4 log on
D+65. CMV titres were less than 150 on D+70. He received Injectable Artesunate for 30 days and
Oral Leflunomide for 44 days.

INTRODUCTION: CMV Reactivation is more common in Halpoidentical SCT as the immune
reconstitution is delayed in them in view of prolonged immunosuppressive therapy. CMV disease
forms % of non relapse mortality in Haploidentical SCT which can be best prevented by timely usage
of prememptive therapy. The toxicity profile of drugs like Ganciclovir, Cidofovir and Foscarnet are
limits their usage in treating CMV infection and also due to lack of newer specific antivirals, newer
non toxic anti CMV drugs would gain importance in treating this infection. We would like to share our
experience with Leflunomide and Artesunate used for the treatment of CMV infection with one of
our patients.

RESULTS: Leflunomide with Artesunate in combination was effective in reducing the CMV titres. The
time to decline 1 log reduction was 7 days and 4 log reduction was 15 days after the addition of
artesunate.

CONCLUSION: Leflunomide and Artesunate are safe alternative as a prememptive therapy for CMV
infections without any untoward side effects.