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Clin Microbiol Infect. 2018 Jun;24 Suppl 2:S71-S82. doi: 10.1016/j.cmi.2018.02.003. Epub 2018 Feb 12.

ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Agents targeting lymphoid cells surface antigens [I]: CD19, CD20 and CD52).

Author information

1
Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy. Electronic address: m.mikulska@unige.it.
2
Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
3
Department of Infectious Diseases, University Hospital of Bellvitge, IDIBELL, Barcelona, Spain.
4
Department of Oncohaematology, Comenius University and National Cancer Institute, Bratislava, Slovakia.
5
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
6
Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.

Abstract

BACKGROUND:

The present review is part of the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies.

AIMS:

To review, from an Infectious Diseases perspective, the safety profile of agents targeting CD19, CD20 and CD52 and to suggest preventive recommendations.

SOURCES:

Computer-based MEDLINE searches with MeSH terms pertaining to each agent or therapeutic family.

CONTENT:

Although CD19-targeted agents (blinatumomab or inebilizumab) are not associated with an increased risk of infection, they may cause IgG hypogammaglobulinaemia and neutropenia. The requirement for prolonged intravenous infusion of blinatumomab may increase the risk of catheter-associated bloodstream infections. Infection remains the most common non-haematological adverse effect of anti-CD20 monoclonal antibodies, including severe respiratory tract infection, hepatitis B virus (HBV) reactivation and varicella-zoster virus infection. Screening for chronic or resolved HBV infection is recommended for patients receiving anti-CD20 monoclonal antibodies. Antiviral prophylaxis should be offered for 12-18 months to hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative/anti-hepatitis B core antibody (HBc)-positive patients. Anti-Pneumocystis prophylaxis should be considered in patients receiving concomitant chemotherapy, particularly steroids. Alemtuzumab (anti-CD52) increases the risk of infections, in particular among leukaemia and solid organ transplant patients. These populations benefit from anti-Pneumocystis prophylaxis, prevention strategies for cytomegalovirus infection, and screening for HBV, hepatitis C virus and tuberculosis. Antiviral prophylaxis for at least 6-12 months should be provided for HBsAg-positive patients.

IMPLICATIONS:

As there are limited clinical data for many of the reviewed agents, special attention must be given to promptly detect and report emerging infectious complications.

KEYWORDS:

Alemtuzumab; Anti-CD20 monoclonal antibodies; Blinatumomab; Hepatitis B virus; Inebilizumab; Infection; Rituximab

PMID:
29447988
DOI:
10.1016/j.cmi.2018.02.003
[Indexed for MEDLINE]

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