Reactivation of tuberculosis following ruxolitinib therapy for primary myelofibrosis: Case series and literature review

Khalid, Farhan; Damlaj, Moussab; Alzahrani, Mohsen; Abuelgasim, Khadega A.; Gmati, Giamal

doi:10.1016/j.hemonc.2020.02.003

Cited by 17 publications

(14 citation statements)

References 20 publications

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“…Susceptibility to opportunistic infections in patients under ruxolitinib therapy has already been documented, with many reports of mycobacterial and viral infections. [3][4][5] Recent data also warn of a possible increased risk of developing aggressive lymphomas with JAK inhibitors, with a delay of several months between the initiation of JAK inhibitor and the diagnosis of lymphoma, 6 which is consistent with our case and assumes a role of ruxolitinibinduced immune suppression in the pathogenesis of these lymphomas. Reactive lymphocytosis secondary to EBV reactivation in a patient under ruxolitinib has been described elsewhere, 7 and one of the aggressive lymphomas described in patients under ruxolitinib was positive for EBV 6 , but no CHL-like EBV-associated lymphoproliferative disorder has been described in patients under ruxolitinib.…”

supporting

confidence: 89%

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

et al. 2020

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supporting

confidence: 89%

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

et al. 2020

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“…In a meta-analysis including 414 patients with cGVHD, during treatment with Ruxolitinib infections occurred in 20 % of patients, more frequently sustained by bacteria (55 %) and CMV (39 %) [49]. The proinfective aspect of Ruxolitinib is also evident in myelofibrosis, where cases of hepatitis B [50] and tuberculosis (in 1.4 % of cases) [51] reactivation, in addition to pneumonitis sustained by Pneumocystis jiroveci [52], have been reported. In the last weeks, 8 clinical trials with Ruxolitinib in COVID-19 started, with dose ranging from 10 to 20 mg/day.…”

Section: Jak2 Inhibitorsmentioning

confidence: 99%

The CoV-2 outbreak: how hematologists could help to fight Covid-19

Galimberti

Baldini

Baratè³

et al. 2020

Pharmacological Research

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COVID-19 is a medical emergency, with 20 % of patients presenting with severe clinical manifestations. From the pathogenetic point of view, COVID-19 mimics two other well-known diseases characterized by cytokine storm and hyper-activation of the immune response, with consequent organ damage: acute graft-versus-host disease (aGVHD) and macrophage activation syndrome (MAS). Hematologists are confident with these situations requiring a prompt therapeutic approach for switching off the uncontrolled cytokine release; here, we discuss pros and cons of drugs that are already employed in hematology in the light of their possible application in COVID-19. The most promising drugs might be: Ruxolitinib, a JAK1/2 inhibitor, with a rapid and powerful anticytokine effect, tyrosine kinase inhibitors (TKIs), with their good anti-inflammatory properties, and perhaps the anti-Cd26 antibody Begelomab. We also present immunological data from gene expression experiments where TKIs resulted effective anti-inflammatory and pro-immune drugs. A possible combined treatment algorithm for COVID-19 is here proposed.

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“…By the end of April 2020, 23 cases of ruxrelated TB were described in 17 published case reports (Table 1). [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Our two cases are listed in this table and will be analyzed as well.…”

Section: Dovepressmentioning

confidence: 99%

<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

Peng

et al. 2020

IDR

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Background: The selective Janus-activated kinase inhibitor ruxolitinib (rux) is now widely used to treat myelofibrosis and polycythemia vera due to its remarkable effect of reducing splenomegaly and improving constitutional symptoms. With opportunistic infections secondary to rux constantly reported; however, an increasing number of studies have begun to investigate the mechanism and underlying immunosuppressive effect of rux. Case Presentation: We report two cases of tuberculosis (TB) in primary myelofibrosis patients during rux therapy. The first patient received rux soon after diagnosis, and tracheobronchial TB (TBTB) and bronchoesophageal fistula were found after 4 months. After discontinuation of rux, antituberculosis therapy (ATT) was introduced. The second patient initiated rux due to progressive splenomegaly after 7.5 years of interferon therapy and was diagnosed with disseminated TB after 2 months. He received ATT as well. His rux was maintained due to the high burden of systematic symptoms and splenomegaly. Both myelofibrosis and TB were well controlled in these patients. Conclusion: This is the first case report that describes rux-related TBTB accompanied by a bronchoesophageal fistula. Through a review of the literature, we provide supporting evidence to the finding that intrinsic disorders of myeloproliferative neoplasms and rux-induced immunologic deregulation together lead to TB. We highlight the importance of screening for latent TB infection and timely chemoprophylaxis before rux therapy. Once TB is diagnosed during treatment, rux is recommended to be stopped and active ATT should begin quickly.

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Reactivation of tuberculosis following ruxolitinib therapy for primary myelofibrosis: Case series and literature review

Cited by 17 publications

References 20 publications

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

The CoV-2 outbreak: how hematologists could help to fight Covid-19

<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

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