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Khatri AM, Natori Y, Anderson A, Jabr R, Shah SA, Natori A, Chandhok NS, Komanduri K, Morris MI, Camargo JF, Raja M. Breakthrough invasive fungal infections on isavuconazole prophylaxis in hematologic malignancy & hematopoietic stem cell transplant patients. Transpl Infect Dis 2023; 25 Suppl 1:e14162. [PMID: 37794708 DOI: 10.1111/tid.14162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Isavuconazole (ISA) is a newer antifungal used in patients with history of hematologic malignancies and hematopoietic transplant and cellular therapies (HM/TCT). Although it has a more favorable side-effect profile, breakthrough invasive fungal infections (bIFIs) while on ISA have been reported. METHODS In this single-center retrospective study evaluating HM/TCT patients who received prophylactic ISA for ≥7 days, we evaluated the incidence and potential risk factors for bIFIs. RESULTS We evaluated 106 patients who received prophylactic ISA. The patients were predominantly male (60.4%) with median age of 65 (range: 21-91) years. Acute myeloid leukemia (48/106, 45.3%) was the most common HM, with majority having relapsed and/or refractory disease (43/106, 40.6%) or receiving ongoing therapy (38/106, 35.8%). Nineteen patients (17.9%) developed bIFIs-nine proven [Fusarium (3), Candida (2), Mucorales plus Aspergillus (2), Mucorales (1), Colletotrichum (1)], four probable invasive pulmonary Aspergillus, and six possible infections. Twelve patients were neutropenic for a median of 28 (8-253) days prior to bIFI diagnosis. ISA levels checked within 7 days of bIFI diagnosis (median: 3.65 μg/mL) were comparable to industry-sponsored clinical trials. All-cause mortality among the bIFI cases was 47.4% (9/19).We also noted clinically significant cytomegalovirus co-infection in 5.3% (1/19). On univariate analysis, there were no significant differences in baseline comorbidities and potential risk factors between the two groups. CONCLUSION ISA prophylaxis was associated with a significant cumulative incidence of bIFIs. Despite the appealing side-effect and drug-interaction profile of ISA, clinicians must be vigilant about the potential risk for bIFIs.
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Affiliation(s)
- Akshay M Khatri
- Division of Infectious Diseases, Department of Medicine, UnityPoint Health-Des Moines, Des Moines, USA
| | - Yoichiro Natori
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
- Miami Transplant Institute, Jackson Health System, Miami, USA
| | - Anthony Anderson
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, USA
| | - Ra'ed Jabr
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Health System-Eau Claire, Miami, USA
| | - Shreya A Shah
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, USA
| | - Akina Natori
- Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Namrata S Chandhok
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Krishna Komanduri
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Michele I Morris
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Jose F Camargo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Mohammed Raja
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
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Jabr R, Khatri A, Anderson AD, Garcia LC, Viotti JB, Natori Y, Raja M, Camargo JF, Morris MI. Early administration of SARS-CoV-2 monoclonal antibody reduces the risk of mortality in hematologic malignancy and hematopoietic cell transplant patients with COVID-19. Transpl Infect Dis 2023; 25:e14006. [PMID: 36704987 DOI: 10.1111/tid.14006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/18/2022] [Accepted: 10/12/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Data on severe acute respiratory distress syndrome coronavirus 2 monoclonal antibody (SARS-CoV-2-specific mAb) use in hematologic malignancy and hematopoietic cell transplantation (HM/HCT) patients are limited. Here, we describe our experience with the use of casirivimab-imdevimab or bamlanivimab for the treatment of coronavirus disease 2019 (COVID-19) in HM/HCT patients. METHODS This was a retrospective chart review at the University of Miami Hospital and Sylvester Comprehensive Cancer Center for HM/HCT patients with COVID-19 who received casirivimab-imdevimab or bamlanivimab from November 21, 2020, to September 30, 2021. Outcomes measured were mortality, hospital admission, and infusion reaction to SARS-CoV-2-specific mAbs. RESULTS We identified 59 HM/HCT patients with mild to moderate COVID-19 who received casirivimab-imdevimab or bamlanivimab. Median age was 57 years (interquartile range [IQR]: 45-65). Among the 59 patients, 25 (42%) received cellular therapy: 14 (24%) had undergone allogeneic HCT, nine (15%) autologous HCT, and two (3%) received chimeric antigen receptor T-cell therapy. The median time from COVID-19 symptom onset to SARS-CoV-2-specific mAb administration was 4 (IQR: 3-6) days. Forty-six (78%) patients received SARS-CoV-2-specific mAbs as outpatients and 13 (22%) patients received SARS-CoV-2-specific mAbs during hospitalization. Among patients who received SARS-CoV-2-specific mAbs as outpatients, only four (9%) visited the emergency department at days 10, 11, 15, and 35 after SARS-CoV-2-specific mAb administration. None of these four patients required hospital admission. Among the hospitalized patients, five (38%) were admitted to the hospital with neutropenic fever, four (31%) were already hospitalized for transplantation and cellular therapy, three (23%) were admitted for monitoring of COVID-19 symptoms, and one (8%) was admitted with acute kidney injury. Three hospitalized patients (23%) died at 14, 35, and 59 days after SARS-CoV-2-specific mAb administration; two of these three deaths were attributed to COVID-19 infection. One patient developed an immediate infusion reaction to bamlanivimab, and no infusion reactions were reported to casirivimab-imdevimab use. CONCLUSION During the alpha and delta variant surges, early administration of bamlanivimab or casirivimab-imdevimab prevented hospitalization and death when given in the outpatient setting. Among patients who received mAbs at or after hospital admission, the risk of COVID-19 disease progression and death remains significant. Larger studies of the use of mAb therapy to treat COVID-19 in this population are needed.
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Affiliation(s)
- Ra'ed Jabr
- Division of Infectious Diseases, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Akshay Khatri
- Division of Infectious Diseases, UnityPoint Health, Des Moines, Iowa, USA
| | - Anthony D Anderson
- Department of Pharmacy, University of Miami Health System, Miami, Florida, USA
| | - Leopoldo Cordova Garcia
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Julia Bini Viotti
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Mohammed Raja
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jose F Camargo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michele I Morris
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
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Jabr R, Liesman RM, Sethapati VR, Shoemaker DM, Spec A, El Atrouni W. Disseminated Infection Due to Neocosmospora (Fusarium) falciformis in a patient with Acute Myelogenous Leukemia. Kans J Med 2022; 15:67-69. [PMID: 35371386 PMCID: PMC8942587 DOI: 10.17161/kjm.vol15.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ra'ed Jabr
- Department of Internal Medicine, Division of Infectious Diseases, University of Miami/Jackson Health System, Miami, FL
| | - Rachael M Liesman
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Venkata Rakesh Sethapati
- Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, CA
| | - D Matthew Shoemaker
- Department of Internal Medicine, Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
| | - Andrej Spec
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Wissam El Atrouni
- Department of Internal Medicine, Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
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Jabr R, Woodroof J, Eid AJ. A skin ulcer in a returning traveler caused by Leishmania panamensis. Int J Infect Dis 2020; 103:514-515. [PMID: 33301992 DOI: 10.1016/j.ijid.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ra'ed Jabr
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Janet Woodroof
- Department of Pathology & Laboratory Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Albert J Eid
- Department of Internal Medicine, Division of Infectious Diseases, The University of Kansas Medical Center, Kansas City, KS, USA.
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Jabr R, Hammoud K. Scedosporium apiospermum fungemia successfully treated with voriconazole and terbinafine. IDCases 2020; 22:e00928. [PMID: 32884903 PMCID: PMC7452905 DOI: 10.1016/j.idcr.2020.e00928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022] Open
Abstract
Scedosporium apiospermum is ubiquitous in the environment and is considered an emerging infection. Immunocompromised hosts can have a wide spectrum of diseases ranging from cutaneous to disseminated disease that may involve pulmonary, central nervous system, or bone. Disseminated disease in immunocompetent hosts is uncommon. Treatment of deep-seated infections is challenging because of the limited susceptibility of the Scedosporium species to all current antifungal drugs. We report a case of Scedosporidium apiospermum fungemia with a presumed pulmonary involvement in an immunocompetent patient. The fungemia was successfully treated with oral voriconazole and terbinafine.
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Affiliation(s)
- Ra'ed Jabr
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kassem Hammoud
- Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Jabr R, Hammoud K. CNS Infection Mimicking Stroke. Kans J Med 2020. [DOI: 10.17161/kjm.v13i1.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Howlett PJ, Morritt J, Jabr R, Mahmoudi M, Fry CH, Leatham EW. 70 * Targeted screening for paroxysmal atrial fibrillation: prolonged monitoring significantly increases diagnostic yield. Europace 2014. [DOI: 10.1093/europace/euu243.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Howlett P, Morritt J, Greswell L, Findlay N, Mahmoudi M, Waheed A, Jabr R, Fry C, Leatham E. 81 * Symptom frequency is a poor predictor of onset of paroxysmal atrial fibrillation in a population presenting with palpitations. Europace 2014. [DOI: 10.1093/europace/euu244.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Qasem A, Fry C, Jabr R. 206 ASSESSMENT OF GAP JUNCTION COMMUNICATION BETWEEN HUMAN UMBILICAL ENDOTHELIAL CELLS AND MONOCYTES IN RESPONSE TO TUMOUR NECROSIS FACTOR (TNF-Α). Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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