An update on the treatment of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

ABSTRACT

Introduction: Human Cytomegalovirus (CMV) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Standard treatment options have for long been limited to a small number of effective drugs with significant toxicities.

Areas covered: In this manuscript, the authors update a previous review summarizing recent developments in the virology lab and their possible implications for treatment strategies at bedside. In particular, the authors focused on new antiviral drugs already available and under investigation in clinical trials and innovative immunotherapeutic approaches, including adoptive T-cell therapy and vaccines.

Expert opinion: Broader knowledge of CMV biology and its relationship with the host immune system is greatly contributing to the development of novel therapeutic approaches. The availability of new drugs, the improved techniques for virological testing and the more accurate patient risk stratification allow to better individualize treatment, limiting toxicity while sparing antiviral effects. The role of immunotherapy is clearly emerging and will further expand our treatment armamentarium.

KEYWORDS:

• Cytomegalovirus (CMV)
• immune response
• CMV-vaccine
• hematopoietic stem cell transplantation (HSCT)
• adoptive T-cell therapy (ATCT)
• CMV infection
• CMV viral load monitoring
• immune monitoring
• antiviral drugs

Article highlights

• Most current antiviral drugs against CMV remain associated with severe side effects and potential drug-resistance despite remarkable process.

• Newer antiviral compounds are emerging as promising agents against CMV-resistant strains and may have a role in both the prophylactic/pre-emptive and therapeutic settings.

• Prospective CMV monitoring in the virology lab will be a key factor to guide therapeutic interventions and significantly improve clinical outcomes.

• Off-the-shelf third-party CMV-specific T-cells alone or in combination with CMV-specific drugs with an acceptable toxicity profile may become crucial for the treatment of life-threatening CMV disease in critically ill patients.

• A wide-spread role of CMV-vaccination remains to be fully determined.

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.