Cytomegalovirus in hematopoietic stem cell transplant recipients - management of infection.
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.
a Dipartimento di Oncoematologia Pediatrica , IRCSS Ospedale Pediatrico Bambino Gesù , Rome , Italy.|b Dipartimento di Scienze Pediatriche , Università di Pavia , Pavia , Italy.
Franco
F
Locatelli
a Dipartimento di Oncoematologia Pediatrica , IRCSS Ospedale Pediatrico Bambino Gesù , Rome , Italy.
Alice
A
Bertaina
a Dipartimento di Oncoematologia Pediatrica , IRCSS Ospedale Pediatrico Bambino Gesù , Rome , Italy.
Valentina
V
Bertaina
a Dipartimento di Oncoematologia Pediatrica , IRCSS Ospedale Pediatrico Bambino Gesù , Rome , Italy.
Pietro
P
Merli
D000998:Antiviral Agents / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000009:adverse effects; D003587:Cytomegalovirus / Q000276:immunology / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D022482:Cytomegalovirus Vaccines / Q000008:administration & dosage / Q000276:immunology; D024882:Drug Resistance, Viral; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007113:Immunity, Innate; D016219:Immunotherapy, Adoptive; D016131:Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism; D014019:Tissue Donors; D066027:Transplant Recipients; D014775:Virus Activation / Q000276:immunology; D014779:Virus Replication
D000998:Antiviral Agents; D022482:Cytomegalovirus Vaccines
CMV infection; CMV vaccines; adoptive T-cell therapy; anti-viral drugs; generation of CMV-specific T cells; immune monitoring; monitoring of CMV viral load