New Developments in the Management of Cytomegalovirus Infection After Transplantation

Atibordee Meesing, Raymund R Razonable

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Cytomegalovirus (CMV) continues to be one of the most important pathogens that universally affect solid organ and allogeneic hematopoietic stem cell transplant recipients. Lack of effective CMV-specific immunity is the common factor that predisposes to the risk of CMV reactivation and clinical disease after transplantation. Antiviral drugs are the cornerstone for prevention and treatment of CMV infection and disease. Over the years, the CMV DNA polymerase inhibitor, ganciclovir (and valganciclovir), have served as the backbone for management, while foscarnet and cidofovir are reserved for the management of CMV infection that is refractory or resistant to ganciclovir treatment. In this review, we highlight the role of the newly approved drug, letermovir, a viral terminase inhibitor, for CMV prevention after allogeneic hematopoietic stem cell transplantation. Advances in immunologic monitoring may allow for an individualized approach to management of CMV after transplantation. Specifically, the potential role of CMV-specific T-cell measurements in guiding the need for the treatment of asymptomatic CMV infection and the duration of treatment of CMV disease is discussed. The role of adoptive immunotherapy, using ex vivo-generated CMV-specific T cells, is highlighted. This article provides a review of novel drugs, tests, and strategies in optimizing our current approaches to prevention and treatment of CMV in transplant recipients.

Original languageEnglish (US)
Pages (from-to)1-19
Number of pages19
JournalDrugs
DOIs
StateAccepted/In press - Jun 30 2018

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Cytomegalovirus Infections
Cytomegalovirus
Transplantation
Ganciclovir
Foscarnet
Nucleic Acid Synthesis Inhibitors
T-Lymphocytes
Adoptive Immunotherapy
Therapeutics
Immunologic Monitoring
Asymptomatic Infections
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Pharmaceutical Preparations
Antiviral Agents
Immunity
Transplants

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

New Developments in the Management of Cytomegalovirus Infection After Transplantation. / Meesing, Atibordee; Razonable, Raymund R.

In: Drugs, 30.06.2018, p. 1-19.

Research output: Contribution to journalArticle

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