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Review
. 2021;13(3):123-140.
doi: 10.1007/s40506-021-00253-w. Epub 2021 Jul 21.

CMV Infection in Hematopoietic Stem Cell Transplantation: Prevention and Treatment Strategies

Niyati Jakharia  1 , Dianna Howard  2 , David J Riedel  3
Affiliations
Review

CMV Infection in Hematopoietic Stem Cell Transplantation: Prevention and Treatment Strategies

Niyati Jakharia et al. Curr Treat Options Infect Dis. 2021.

Abstract

Purpose of review: Cytomegalovirus (CMV) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). New strategies and methods for prevention and management of CMV infection are urgently needed. We aim to review the new developments in diagnostics, prevention, and management strategies of CMV infection in Allo-HSCT recipients.

Recent findings: The approval of the novel anti-CMV drug letermovir in 2017 has led to an increase in the use of antiviral prophylaxis as a preferred approach for prevention in many centers. Real-world studies have shown efficacy similar to the clinical trial. CMV-specific T cell-mediated immunity assays identify patients with immune reconstitution and predict disease progression. Phase 2 trials of maribavir have shown its efficacy as preemptive therapy and treatment of resistant and refractory CMV infections. Adoptive T cell therapy is an emerging option for treatment of refractory and resistant CMV. Of the different CMV vaccine trials, PepVax has shown promising results in a phase 1 trial.

Summary: CMV cell-mediated immunity assays have potential to be used as an adjunctive test to develop individualized management plan by identifying the patients who develop immune reconstitution; however, further prospective interventional studies are needed. Maribavir and adoptive T cell therapy are promising new therapies for treatment of CMV infections. CMV vaccine trials for prevention are also under way.

Keywords: CMV infection; Hematopoietic stem cell transplantation; Letermovir.

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Conflict of interest statement

Conflict of InterestNiyati Jakharia declares that she has no conflict of interest. Dianna Howard declares that she has no conflict of interest. David J. Riedel declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1
Proposed algorithm for implementation of CMV-CMI assays for monitoring and interventions.
Fig. 2
Fig. 2
Proposed algorithm for management of CMV infection in stem cell transplant population.
See this image and copyright information in PMC

References

References and Recommended Reading

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