Bezlotoxumab As Treatment for Recurrent/Chronic Clostridioides Difficile Infection in Stem Cell Transplant Recipients
Abstract
Introduction
Clostridioides difficile infection (CDI) represents a significant health risk to pediatric stem cell transplant (SCT) patients, leading to increased comorbidity and mortality. Due to prolonged immunosuppression in the post-transplant period, CDI is frequently complicated by recurrent disease, requiring repeated, prolonged antibiotic usage and increased rates of hospitalization. Therefore, there is a need for other adjunct therapies to treat recurrent CDI (rCDI) in the pediatric population. Bezlotoxumab is a human monoclonal antibody that has demonstrated efficacy in pediatric patients based on the recent MODIFY III trial results. However, the safety and efficacy of bezlotuxumab has not been studied in pediatric patients undergoing a SCT, and no data exists to detail its impact on common immunosuppressants such as tacrolimus and mycophenolate mofetil (MMF). We describe here two cases where bezlotoxumab was used in conjunction with conventional antibiotic therapy to treat rCDI in pediatric SCT patients without disease recurrence as indicated by absence of symptoms.
Methods
This was a retrospective chart review of pediatric patients with rCDI who received a SCT at MD Anderson Cancer Center.
Results
Case 1
A 6-year-old female was diagnosed at 2 years old with MLL/KMT2A acute myeloid leukemia (AML). The patient first developed C. difficile colitis prior to her first transplant, which was confirmed via DNA and toxin EIA testing. The patient required a prolonged oral…
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