Table 2.
Risk infections with new targeted therapies (Adapted from [25]).
| Treatment | Drugs | Approved Indications | Infectious Complications | Prophylaxis Suggestions |
|---|---|---|---|---|
| Immune checkpoint inhibitor | ||||
| CTLA-4 targeted agents | Ipilimumab Tremelimumab |
Melanoma | Does not appear independently associated with the occurrence of infection but combination with treatment (corticosteroids and/or TNF-α) for irAEs increased infectious risk | Anti-Pneumocystis prophylaxis for patients who are expected to receive 20 mg of prednisone daily for at least 4 weeks Hepatitis B and C: prophylaxis or therapy if needed. |
| (PD)-1 and (PD-L1) targeted agents | Nivolumab Pembrolizumab Atezolizumab |
Melanoma Non-small cell lung cancer Head and neck carcinoma Hodgkin lymphoma Metastatic renal cell carcinoma (nivolumab) Urothelial carcinoma and lung cancer (atezolizumab) |
||
| BTK inhibitor | Ibrutinib Acalabrutinib Zanubrutinib |
Mantle cell lymphoma Chronic lymphocytic leukemia Waldenström macroglobulinemia Marginal zone lymphoma |
Fungal infections: Aspergillus, Pneumocystis jirovecii | Assess antifungal prophylaxis or screening for fungal infections Anti-Pneumocystis prophylaxis in patients treated with corticosteroids |
| Bacterial infections: Staphylococcus aureus Mycobacterium tuberculosis | ||||
| PI3K inhibitors | Idelalisib Duvelisib Umbralisib |
Chronic lymphocytic leukemia Lymphoid malignancies |
Fungal infections: Pneumocystis jirovecii | CMV serology be performed prior to treatment initiation and that CMV viral load be measured monthly. Acyclovir prophylaxis is also recommended |
| Viral infections: CMV, HSV and VZV reactivation | ||||
| Antiapoptotic protein BCL-2 inhibitors | Venetoclax | Chronic lymphocytic leukemia Acute myeloid leukemia |
Bacterial infections | |
| Fungal infections | ||||
| JAK inhibitors | Myeloproliferative neoplasms | Bacterial infections: mycobacterial infections | Chronic HBV infection and latent tuberculosis screening | |
| Fungal infections: Pneumocystis jirovecii, Cryptococcus spp. | ||||
| Viral infections: HSV, VZV, JC virus, HBV reactivation | ||||
| CAR-T cells | Large B-cell lymphoma Acute lymphoblastic leukemia Mantle cell lymphoma Multiple myeloma |
Fungal infections: Aspergillus spp., Fusarium spp., Mucorales, Pneumocystis jirovecii | Anti-Pneumocystis prophylaxis (trimethoprim/sulfamethoxazole) Assess antifungal prophylaxis or screening for fungal infections |
|
| Bacterial infections including Clostridioides difficile infections | G-CSF in case of prolonged neutropenia | |||
| Viral infections: respiratory syncytial virus, cytomegalovirus, influenza, polyomaviruses, SARS-CoV-2 | Acyclovir for at least 3–6 months after CAR-T cell therapy Antiviral therapy for hepatitis B virus in case of positive HbS Ag or AntiHbC Ac alone |
BTK: Bruton’s Tyrosin Kinase, CMV: Cytomegalovirus, CTLA-4: Cytotoxic-T-lymphocyte-Antigen 4, G-CSF: Granulocyte Colony Stimulating Factor, HBV: Hepatitis B virus, HSV: Herpes Simplex Virus, irAEs: immune related adverse events, JAK: Janus Kinase, JC: John Cunningham, PD-1: Programmed cell death protein 1, PD-L1: Programmed cell death protein ligand-1 PI3K: Phosphatidylinositol 3-kinase, VZV: Varicella Zona Virus.