Reduced Mortality of Cytomegalovirus Pneumonia After Hematopoietic Cell Transplantation Due to Antiviral Therapy and Changes in Transplantation Practices

Abstract

Outcome of CMV pneumonia showed a modest improvement over the past 25 years. However, advances seem to be due to antiviral treatment and changes in transplant practices rather than immunoglobulin-based treatments. Novel treatment strategies for CMV pneumonia are needed.

Outcomes in Transplant Recipients Treated With Foscarnet for Ganciclovir-Resistant or Refractory Cytomegalovirus Infection

“…Regarding adjunctive intravenous immunoglobulin treatment, Florescu et al, in their international survey of CMV prevention and treatment practices in intestinal transplantation, found that 65% of programs used IVIg or CMVIg for various indications, most commonly adjunctive treatment of CMV pneumonitis, meningoencephalitis, and enteritis 8 . Although the authors commented that IVIg and CMVIg use is probably more common in intestinal transplantation than in other solid organ transplants, this still represents a substantial use of costly therapies with little evidence base outside of CMV pneumonitis in bone marrow transplant recipients 7 . A more detailed study of these practices is warranted if we are to define the optimal management for patients with resistant or refractory CMV infection.…”

“…High-dose ganciclovir 4 , or combinations of ganciclovir and foscarnet 5–6 , are variably effective. CMV immune globulin (CMVIg) is frequently added, although there is little evidence for efficacy in treatment of active infection 7–8 . Leflunomide has been used off-label for CMV treatment, but is not always effective 9 .…”

Cytomegalovirus viremia, disease, and impact on relapse in T-cell replete peripheral blood haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide

“…9,15 While few in absolute numbers, those who died of CMV and those who developed late CMV viremia tended to have acute or chronic GvHD more frequently, requiring steroids, but there was no obvious association with the conditioning regimen.…”

Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis

“…[2][3][4][5][6] However, the need for novel therapies remain, as current antiviral therapy is associated with significant side effects including renal insufficiency and bone marrow suppression, and certain viral infections in HCT patients, like CMV pneumonia, 7 are associated with high mortality rates. Some single-center studies have noted an unexpected association of positive CMV serology or early (before 100 days after HCT [D100]) CMV reactivation with decreased incidence of hematologic disease relapse following allogeneic HCT.…”