Cytomegalovirus disease in hematopoietic stem cell transplant patients: current and future therapeutic options

Curr Opin Infect Dis. 2017 Aug;30(4):372-376. doi: 10.1097/QCO.0000000000000375.

Abstract

Purpose of review: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become one of the standard treatment for hematological diseases. Although the clinical outcome has improved significantly during the last decades, the morbidity and mortality after allo-HSCT are still obstacles to cure. Out of major morbidities, opportunistic virus infections such as cytomegalovirus (CMV) infection are important complications, in particular in patients who received human leukocyte antigen-mismatched HSCT. Here, we aim to summarize information about current and future therapeutic options in CMV disease after allo-HSCT.

Recent findings: Recently, not only new drugs but also adoptive T-cell therapy are tested in the setting of clinical trials. CMV prophylaxis using letermovir significantly reduced the incidence of CMV disease in comparison to placebo in a phase III clinical trial. Meanwhile, adoptive T-cell therapies which are fully adapted to good manufacturing practice (GMP) conditions are now available. A recent multicenter study in Germany showed a promising result using Streptamer-isolated T-cell therapy.

Summary: With the recent development of CMV-targeted therapy, treatment strategies of CMV infection would be further sophisticated in the near future. VIDEO ABSTRACT: http://links.lww.com/COID/A19.

Publication types

  • Review

MeSH terms

  • Acetates / therapeutic use
  • Antiviral Agents / therapeutic use
  • Cytomegalovirus
  • Cytomegalovirus Infections / therapy*
  • Forecasting
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Immunotherapy, Adoptive / methods
  • Opportunistic Infections / therapy*
  • Opportunistic Infections / virology
  • Postoperative Complications / therapy*
  • Quinazolines / therapeutic use
  • Transplant Recipients*

Substances

  • Acetates
  • Antiviral Agents
  • Quinazolines
  • letermovir