Infectious complications related to nucleoside analogs and monoclonal antibodies - Monoclonal Antibodies

Infectious complications related to nucleoside analogs and monoclonal antibodies
2006 Oct 27
Maschmeyer G, Haas A.
Medizinische Klinik, Abt. Hamatologie und Onkologie, Klinikum Ernst von Bergmann, Potsdam
Dtsch Med Wochenschr.
Recombinant monoclonal antibodies targeted against cell surface antigens such as CD 20 (rituximab), CD 52 (alemtuzumab), CD 25 (basiliximab) or against tumor necrosis factor (TNF)-alpha (infliximab, etanercept, adalimumab) are in clinical use for a broad range of diseases, resulting in a significant improvement of treatment options for lymphoid malignancies, transplant rejection, rheumatoid arthritis and chronic inflammmatory bowel disease. However, their administration induces a profound and long lasting immunosuppression which may be associated with serious infections in selected patients. Invasive bacterial and fungal infections as well as systemic viral infections, preferably due to cytomegalovirus (CMV), and mycobacterial infections may emerge particularly in patients treated with alemtuzumab and TNF antibodies. Nucleoside analogs such as fludarabine or cladribine induce a severe T cell suppression putting patients at risk for opportunistic infections caused by CMV, PNEUMOCYSTIS JIROVECI and others. In patients heavily pretreated with immunosuppressive agents, this risk of infectious complications increases significantly. This is particularly important in patients with malignant lymphomas treated with a combination (or sequence) of nucleoside analogs and alemtuzumab. Prophylactic administration of antivirals against Herpes viruses as well as cotrimoxazole is mandatory in patients treated with alemtuzumab or nucleoside analogs.
[Article in German]
Subscription is required to view the article in its entirety.