![]() A study by Walker et al in patients receiving antiviral prophylaxis did not find any significant differences in incidence and outcomes of CMV infections between the 3 different sources of stem cells. This delay increases the risk of bacterial and CMV infections early after cord blood transplantation. In an umbilical cord blood transplant, the T cells that are transferred are naïve, and immune reconstitution is delayed. The various sources of stem cell grafts include peripheral blood, bone marrow and umbilical cord blood. Steroids can impair the immune system by inhibiting T cell activation. GVHD also increases the risk of CMV reactivation, especially with the use of systemic steroids. In a study that compared myeloablative vs non-ablative conditioning regimens, the CMV infections were delayed in the non-myeloablative group, but the 1-year incidence was similar in both groups. Myeloablative conditioning regimens are more cytotoxic than reduced intensity or non-myeloablative regimens, but both cause T cell dysfunction. The use of high doses of anti-thymocyte globulin (ATG) for in vivo T cell depletion may be associated with lower survival. The other risk factors that increase the risk of CMV infection after HSCT include in vivo or ex vivo T cell depletion, high dose steroids, HLA mismatched or unrelated donors, and GVHD. The survival and non-relapse mortality is worst for CMV seronegative donor/seropositive recipient (D−/R+), followed by CMV seropositive donor/seropositive recipient (D+/R+). CMV positive serology has been associated with increased transplant-related morbidity and mortality recipient positivity having the greatest impact. CMV vaccine trials for prevention are also under way.ĬMV serostatus is an important factor that determines outcomes after Allo-HSCT. Maribavir and adoptive T cell therapy are promising new therapies for treatment of CMV infections. SummaryĬMV cell-mediated immunity assays have potential to be used as an adjunctive test to develop individualized management plan by identifying the patients who develop immune reconstitution however, further prospective interventional studies are needed. Of the different CMV vaccine trials, PepVax has shown promising results in a phase 1 trial. Adoptive T cell therapy is an emerging option for treatment of refractory and resistant CMV. Phase 2 trials of maribavir have shown its efficacy as preemptive therapy and treatment of resistant and refractory CMV infections. CMV-specific T cell-mediated immunity assays identify patients with immune reconstitution and predict disease progression. ![]() Real-world studies have shown efficacy similar to the clinical trial. The approval of the novel anti-CMV drug letermovir in 2017 has led to an increase in the use of antiviral prophylaxis as a preferred approach for prevention in many centers. We aim to review the new developments in diagnostics, prevention, and management strategies of CMV infection in Allo-HSCT recipients. New strategies and methods for prevention and management of CMV infection are urgently needed. Cytomegalovirus (CMV) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (Allo-HSCT).
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