The clinical impact of cytomegalovirus infection following allogeneic hematopoietic cell transplantation: Why the quest for meaningful prophylaxis still matters.
Latent infection with human cytomegalovirus (CMV) is common. Functional immunity effectively contains such latent infections; however, CMV reactivation may cause significant complications in patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). In spite of the universal implementation of post-transplant screening for CMV viremia and the institution of pre-emptive antiviral management, CMV disease still occurs in a small portion of patients. Moreover, interactions between CMV and the immune system have significant implications for the incidence of graft-versus-host disease, the recurrence of malignancy, and non-relapse mortality following alloHCT, even in the era of pre-emptive antiviral management. CMV serostatus thus remains an important consideration for patients undergoing alloHCT. We review the clinical impact of CMV in the setting of alloHCT, interactions between CMV serostatus, viral reactivation, and transplant outcomes, as well as current and evolving strategies for prevention and treatment of CMV-related complications that may have significant impact for alloHCT recipients.
Division of Hematology and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States.
Shawna T
ST
Chan
Division of Hematology and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States. Electronic address: aaron.logan@ucsf.edu.
Aaron C
AC
Logan
D000998:Antiviral Agents / Q000627:therapeutic use; D018890:Chemoprevention; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D022482:Cytomegalovirus Vaccines / Q000276:immunology; D019468:Disease Management; D024882:Drug Resistance, Viral; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007167:Immunotherapy; D011379:Prognosis; D063189:Symptom Assessment; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000998:Antiviral Agents; D022482:Cytomegalovirus Vaccines
Allogeneic hematopoietic cell transplant; CMV disease; CMV reactivation; Cytomegalovirus; Graft-versus-host disease; Pre-emptive therapy