Abstract
CMV can cause disease in several different organs after SCT. Seropositivity remains a major risk factor for TRM in unrelated SCT patients. In a study using the EBMT registry, CMV-seropositive patients receiving seropositive unrelated donor grafts had improved survival and reduced TRM compared with those receiving seronegative grafts, and a similar result was found in a single center study. Preventive measures can be divided into prevention of a primary infection or recurrence of CMV (prophylaxis) or prevention of development of disease when a reactivation has occurred (preemptive therapy). The standard therapy for CMV pneumonia has been i.v. ganciclovir combined with high-dose Ig, but this standard has never been evaluated in a controlled study and more recent studies have questioned whether the addition of Ig improves outcome.
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Nichols WG, Corey L, Gooley T, Davis C, Boeckh M . High risk of death due to bacterial and fungal infection among cytomegalovirus (CMV)-seronegative recipients of stem cell transplants from seropositive donors: evidence for indirect effects of primary CMV infection. J Infect Dis 2002; 185: 273–282.
Ringden O, Schaffer M, Le Blanc K, Persson U, Hauzenberger D, Abedi MR et al. Which donor should be chosen for hematopoietic stem cell transplantation among unrelated HLA-A, -B, and -DRB1 genomically identical volunteers? Biol Blood Marrow Transplant 2004; 10: 128–134.
Boeckh M, Nichols WG . The impact of cytomegalovirus serostatus of donor and recipient before hematopoietic stem cell transplantation in the era of antiviral prophylaxis and preemptive therapy. Blood 2004; 103: 2003–2008.
Bowden RA, Slichter SJ, Sayers MH, Mori M, Cays MJ, Meyers JD . Use of leukocyte-depleted platelets and cytomegalovirus-seronegative red blood cells for prevention of primary cytomegalovirus infection after marrow transplant. Blood 1991; 78: 246–250.
Nichols WG, Price TH, Gooley T, Corey L, Boeckh M . Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products. Blood 2003; 101: 4195–4200.
Ljungman P, Larsson K, Kumlien G, Aschan J, Barkholt L, Gustafsson-Jernberg A et al. Leukocyte depleted, unscreened blood products give a low risk for CMV infection and disease in CMV seronegative allogeneic stem cell transplant recipients with seronegative stem cell donors. Scand J Infect Dis 2002; 34: 347–350.
Bowden R, Cays M, Schoch G, Sayers M, Slichter S, Welk K et al. Comparison of filtered blood (FB) to seronegative blood products (SB) for prevention of cytomegalovirus (CMV) infection after marrow transplant. Blood 1995; 86: 3598–3603.
Prentice HG, Gluckman E, Powles RL, Ljungman P, Milpied N, Fernandez Ranada JM et al. Impact of long-term acyclovir on cytomegalovirus infection and survival after allogeneic bone marrow transplantation. European Acyclovir for CMV Prophylaxis Study Group. Lancet 1994; 343: 749–753.
Ljungman P, De La Camara R, Milpied N, Volin L, Russell CA, Webster A et al. A randomised study of valaciclovir as prophylaxis against CMV reactivation in allogeneic bone marrow transplant recipients. Blood 2002; 73: 930–936.
Winston DJ, Young JA, Pullarkat V, Papanicolaou GA, Vij R, Vance E et al. Maribavir prophylaxis for prevention of cytomegalovirus infection in allogeneic stem-cell transplant recipients: a multicenter, randomized, double-blind, placebo-controlled, dose-ranging study. Blood 2008.
Marty FM, Bryar J, Browne SK, Schwarzberg T, Ho VT, Bassett IV et al. Sirolimus-based graft-versus-host disease prophylaxis protects against cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation: a cohort analysis. Blood 2007; 110: 490–500.
Reusser P, Einsele H, Lee J, Volin L, Rovira M, Engelhard D et al. Randomized multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood 2002; 99: 1159–1164.
Einsele H, Reusser P, Bornhauser M, Kalhs P, Ehninger G, Hebart H et al. Oral valganciclovir leads to higher exposure to ganciclovir than intravenous ganciclovir in patients following allogeneic stem cell transplantation. Blood 2006; 107: 3002–3008.
Nichols WG, Corey L, Gooley T, Drew WL, Miner R, Huang M et al. Rising pp65 antigenemia during preemptive anticytomegalovirus therapy after allogeneic hematopoietic stem cell transplantation: risk factors, correlation with DNA load, and outcomes. Blood 2001; 97: 867–874.
Gerna G, Lilleri D, Zecca M, Alessandrino EP, Baldanti F, Revello MG et al. Rising antigenemia levels may be misleading in pre-emptive therapy of human cytomegalovirus infection in allogeneic hematopoietic stem cell transplant recipients. Haematologica 2005; 90: 526–533.
Ljungman P, Deliliers GL, Platzbecker U, Matthes-Martin S, Bacigalupo A, Einsele H et al. Cidofovir for cytomegalovirus infection and disease in allogeneic stem cell transplant recipients. The Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Blood 2001; 97: 388–392.
Cesaro S, Zhou X, Manzardo C, Buonfrate D, Cusinato R, Tridello G et al. Cidofovir for cytomegalovirus reactivation in pediatric patients after hematopoietic stem cell transplantation. J Clin Virol 2005; 34: 129–132.
Kaptein SJ, Efferth T, Leis M, Rechter S, Auerochs S, Kalmer M et al. The anti-malaria drug artesunate inhibits replication of cytomegalovirus in vitro and in vivo. Antiviral Res 2006; 69: 60–69.
Levi ME, Mandava N, Chan LK, Weinberg A, Olson JL . Treatment of multidrug-resistant cytomegalovirus retinitis with systemically administered leflunomide. Transpl Infect Dis 2006; 8: 38–43.
Ehlert K, Groll AH, Kuehn J, Vormoor J . Treatment of refractory CMV-infection following hematopoietic stem cell transplantation with the combination of foscarnet and leflunomide. Klin Padiatr 2006; 218: 180–184.
Boeckh M, Leisenring W, Riddell SR, Bowden RA, Huang ML, Myerson D et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood 2003; 101: 407–414.
Machado CM, Dulley FL, Boas LS, Castelli JB, Macedo MC, Silva RL et al. CMV pneumonia in allogeneic BMT recipients undergoing early treatment of pre-emptive ganciclovir therapy. Bone Marrow Transplant 2000; 26: 413–417.
Reusser P, Riddell SR, Meyers JD, Greenberg PD . Cytotoxic T-lymphocyte response to cytomegalovirus after human allogeneic bone marrow transplantation: pattern of recovery and correlation with cytomegalovirus infection and disease. Blood 1991; 78: 1373–1380.
Krause H, Hebart H, Jahn G, Muller CA, Einsele H . Screening for CMV-specific T cell proliferation to identify patients at risk of developing late onset CMV disease. Bone Marrow Transplant 1997; 19: 1111–1116.
Ljungman P . Would monitoring CMV immune responses allow improved control of CMV in stem cell transplant patients. J Clin Virol 2006; 35: 493–495.
Gerna G, Lilleri D, Fornara C, Comolli G, Lozza L, Campana C et al. Monitoring of human cytomegalovirus-specific CD4 and CD8 T-cell immunity in patients receiving solid organ transplantation. Am J Transplant 2006; 6: 2356–2364.
Lilleri D, Fornara C, Furione M, Zavattoni M, Revello MG, Gerna G . Development of human cytomegalovirus-specific T cell immunity during primary infection of pregnant women and its correlation with virus transmission to the fetus. J Infect Dis 2007; 195: 1062–1070.
Cwynarski K, Ainsworth J, Cobbold M, Wagner S, Mahendra P, Apperley J et al. Direct visualization of cytomegalovirus-specific T-cell reconstitution after allogeneic stem cell transplantation. Blood 2001; 97: 1232–1240.
Peggs K, Verfuerth S, Mackinnon S . Induction of cytomegalovirus (CMV)-specific T-cell responses using dendritic cells pulsed with CMV antigen: a novel culture system free of live CMV virions. Blood 2001; 97: 994–1000.
Einsele H, Roosnek E, Rufer N, Sinzger C, Riegler S, Loffler J et al. Infusion of cytomegalovirus (CMV)-specific T cells for the treatment of CMV infection not responding to antiviral chemotherapy. Blood 2002; 99: 3916–3922.
Szmania S, Galloway A, Bruorton M, Musk P, Aubert G, Arthur A et al. Isolation and expansion of cytomegalovirus-specific cytotoxic T lymphocytes to clinical scale from a single blood draw using dendritic cells and HLA-tetramers. Blood 2001; 98: 505–512.
Grigoleit GU, Kapp M, Hebart H, Fick K, Beck R, Jahn G et al. Dendritic cell vaccination in allogeneic stem cell recipients: induction of human cytomegalovirus (HCMV)-specific cytotoxic T lymphocyte responses even in patients receiving a transplant from an HCMV-seronegative donor. J Infect Dis 2007; 196: 699–704.
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Ljungman, P. CMV infections after hematopoietic stem cell transplantation. Bone Marrow Transplant 42 (Suppl 1), S70–S72 (2008). https://doi.org/10.1038/bmt.2008.120
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DOI: https://doi.org/10.1038/bmt.2008.120
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