Therapeutic strategies for cytomegalovirus infection in haematopoietic transplant recipients: a focused update.
BACKGROUND
Cytomegalovirus (CMV) remains a significant cause of morbidity and mortality in immunocompromised patients, particularly following allogeneic haematopoietic transplantation. One of the principal factors leading to this increased risk is the loss of T-cell immunity.


METHODS
In a recent review, we assessed the treatment strategies for prophylaxis and pre-emptive treatment of CMV, particularly where relevant to the high-risk patient populations following allogeneic haematopoietic transplantation. This review is a focused update to our previous article and presents a more detailed analysis of the developments in drugs, vaccines and adoptive T-cell therapies since that time. Relevant studies were selected from PubMed and clinicaltrials.gov. The search terms include allogeneic transplant, cytomegalovirus, multidrug-resistant virus and adoptive T-cell therapy.


CONCLUSIONS
The current randomised controlled studies evaluating pharmacological agents for CMV should inform as to whether these provide significant clinical benefits. Adoptive cell therapy provides a more physiological approach to the problem of lack of CMV-specific immunity. Recent reports add to the evidence that culture-based techniques can create cellular products that are safe and efficacious, although without Phase III data to definitively support their routine application and the difficulty of satisfying GMP standards.
UCL Cancer Institute, Department of Haematology , London, WC1E 6BT , UK karl.peggs@ucl.ac.uk.
Rob S
RS
Sellar
Karl S
KS
Peggs
D000085:Acetates / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000187:drug effects / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000517:prevention & control* / Q000635:transmission; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000379:methods; D063065:Organophosphonates / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D012263:Ribonucleosides / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000276:immunology / Q000637:transplantation; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D004004:Dichlororibofuranosylbenzimidazole / Q000031:analogs & derivatives
D000085:Acetates; D000998:Antiviral Agents; D001562:Benzimidazoles; D003596:Cytosine; D063065:Organophosphonates; D011799:Quinazolines; D012263:Ribonucleosides; C000588473:letermovir; C525733:brincidofovir; C400401:maribavir; D004004:Dichlororibofuranosylbenzimidazole
allogeneic transplant; cellular therapy; cytomegalovirus; immune response