Midostaurin and cyclosporine drug interaction: A case report

WHAT IS KNOWN AND OBJECTIVE: Allogeneic stem cell transplantation patients are often on immunosuppression including calcineurin inhibitors post-transplant for prevention of graft-versus-host disease. Recent data suggested that addition of midostaurin, a FLT-3 mutant kinase inhibitor, maintenance can reduce risk of relapse by 46% at 18 months post-transplant. CASE DESCRIPTION: Patient is a post-allogenetic stem cell transplant patient started on midostaurin for maintenance therapy. Patient had stable serum levels of cyclosporine with a sudden 70% increase in serum level shortly after starting midostaurin. Patient had no other medication changes or laboratory abnormalities that would suggest the change was caused by alternate factors. WHAT IS NEW AND CONCLUSION: This data suggest that midostaurin and cyclosporine have a possible previously unidentified drug interaction leading to elevation immunosuppression serum levels that need to be accounted for in practice.