Cytomegalovirus in hematopoietic stem cell transplant recipients - management of infection

ABSTRACT

Introduction: Cytomegalovirus (CMV) still causes significant morbidity and mortality in patients given allogeneic hematopoietic stem cell transplantation (HSCT). Despite effective pharmacotherapy, potentially life-threatening CMV disease occurs nowadays in up to 10% of HSCT recipients; moreover, routinely used anti-CMV agents have been shown to be associated with morbidity.

Areas covered: This review examines different issues related to diagnosis and management of CMV infection in HSCT recipients, paying particular attention to the monitoring of CMV-specific immune recovery, approaches of adoptive cell therapy and new antiviral drugs.

Expert commentary: Despite advances in diagnostic tests and treatment, there is still room for refining management of CMV in HSCT recipients. Immunological monitoring should be associated in the future to virological monitoring. The safety profile and efficacy of new anti-CMV agents should be compared with that of standard-of-care drugs. Donor-derived, pathogen-specific T cells adoptively transferred after transplantation could contribute to reduce the impact of CMV infection on patient’s outcome.

KEYWORDS:

• CMV infection
• monitoring of CMV viral load
• immune monitoring
• anti-viral drugs
• generation of CMV-specific T cells
• adoptive T-cell therapy
• CMV vaccines

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work was partially supported by grants from AIRC (Associazione Italiana per la Ricerca sul Cancro, progetto speciale 5xmille), PRIN (Progetti di Rilevante Interesse Nazionale) 2010, MIUR (Ministero dell’Istruzione, dell’Università e della Ricerca), Ministero della Salute (Ricerca Finalizzata 2010), from Regione Lazio, IRCCS Ospedale Pediatrico Bambino Gesù and the HO2020 project ‘RETHRIM’ (#643580), to F.L.