Successful treatment of post‐transplant CMV meningoencephalitis with third‐party CMV virus‐specific T cells: Lessons learned

Alonso, Laura; Rudilla, Francesc; Gimeno, Ramón; Codinach, Margarita; Blanco, Miguel; Querol, Sergio; Heredia, Cristina Diaz de

doi:10.1111/petr.13584

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…Most cases (94%) of CMV meningoencephalitis were preceded by recurrent ganciclovir-resistant CMV DNAemia (82%). The remainder had refractory CMV DNAemia while receiving ganciclovir, however 6 patients (35%) did not have active CMV DNAemia at the time of CMV meningoencephalitis ( 54 – 59 ). Of the four patients who survived (three pediatric), two demonstrated a robust cellular immune recovery and another had robust humoral immune recovery.…”

Section: Causative Viral Pathogensmentioning

confidence: 99%

“…Of the four patients who survived (three pediatric), two demonstrated a robust cellular immune recovery and another had robust humoral immune recovery. Therapeutically, one received adjunctive intravenous CMV-hyperimmune globulin, two received pooled immunoglobulin, intrathecal CMV- hyperimmune globulin, and intravenous CMV-directed VST ( 54 , 56 , 58 ).…”

Section: Causative Viral Pathogensmentioning

confidence: 99%

“…Adoptive immunotherapy is a promising therapeutic consideration and may be the only option in cases of UL54 and UL97 mutant strains, although efficacy studies are lacking ( 54 , 131 ). Two pediatric HCT recipients who received CMV-specific VST showed complete recovery after CMV meningoencephalitis in this otherwise fatal disease ( 54 ).…”

Section: Causative Viral Pathogensmentioning

confidence: 99%

“…Adoptive immunotherapy using VST is a promising alternative, and while there are no cases of its use in adenoviral CNS disease, there has been a report of successful VST use in a patient with other virally mediated CNS disease suggesting possible antiviral activity in the CNS ( 54 , 160 , 161 ). Outcomes of adenovirus CNS disease reported in literature remain poor ( 35 ).…”

Section: Causative Viral Pathogensmentioning

confidence: 99%

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Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

Thomas,

Ouellette

2024

Front. Pediatr.

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Neurologic complications, both infectious and non-infectious, are frequent among hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. Up to 46% of HCT and 50% of SOT recipients experience a neurological complication, including cerebrovascular accidents, drug toxicities, as well as infections. Defects in innate, adaptive, and humoral immune function among transplant recipients predispose to opportunistic infections, including central nervous system (CNS) disease. CNS infections remain uncommon overall amongst HCT and SOT recipients, compromising approximately 1% of total cases among adult patients. Given the relatively lower number of pediatric transplant recipients, the incidence of CNS disease amongst in this population remains unknown. Although infections comprise a small percentage of the neurological complications that occur post-transplant, the associated morbidity and mortality in an immunosuppressed state makes it imperative to promptly evaluate and aggressively treat a pediatric transplant patient with suspicion for viral meningoencephalitis. This manuscript guides the reader through a broad infectious and non-infectious diagnostic differential in a transplant recipient presenting with altered mentation and fever and thereafter, elaborates on diagnostics and management of viral meningoencephalitis. Hypothetical SOT and HCT patient cases have also been constructed to illustrate the diagnostic and management process in select viral etiologies. Given the unique risk for various opportunistic viral infections resulting in CNS disease among transplant recipients, the manuscript will provide a contemporary review of the epidemiology, risk factors, diagnosis, and management of viral meningoencephalitis in these patients

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Section: Causative Viral Pathogensmentioning

confidence: 99%

Section: Causative Viral Pathogensmentioning

confidence: 99%

Section: Causative Viral Pathogensmentioning

confidence: 99%

Section: Causative Viral Pathogensmentioning

confidence: 99%

See 2 more Smart Citations

Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

Thomas,

Ouellette

2024

Front. Pediatr.

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“…Six ultimately obtained viral clearance and are long-term survivors (two years) after treatment. Two other cases of pediatric patients successfully treated with third-party CMV-specific T-cells for drug-refractory CMV meningoencephalitis have been reported [ 100 ]. Interestingly, in one of them, persistence of the third-party donor lymphocytes population was demonstrated in blood for at least 7 months post-infusion and the patient did not experience any further significant CMV reactivation during this time period.…”

Section: Clinical Experience In Cns Infectionsmentioning

confidence: 99%

Virus-Specific T-Cell Therapy for Viral Infections of the Central Nervous System: A Review

Lambert

Moussaoui

Baron

et al. 2023

Viruses

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Opportunistic viral infections of the central nervous system represent a significant cause of morbidity and mortality among an increasing number of immunocompromised patients. Since antiviral treatments are usually poorly effective, the prognosis generally relies on the ability to achieve timely immune reconstitution. Hence, strategies aimed at reinvigorating antiviral immune activity have recently emerged. Among these, virus-specific T-cells are increasingly perceived as a principled and valuable tool to treat opportunistic viral infections. Here we briefly discuss how to develop and select virus-specific T-cells, then review their main indications in central nervous system infections, including progressive multifocal leukoencephalopathy, CMV infection, and adenovirus infection. We also discuss their potential interest in the treatment of progressive multiple sclerosis, or EBV-associated central nervous system inflammatory disease. We finish with the key future milestones of this promising treatment strategy.

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Multiple drugs

2020

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Successful treatment of post‐transplant CMV meningoencephalitis with third‐party CMV virus‐specific T cells: Lessons learned

Cited by 7 publications

References 12 publications

Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

Virus-Specific T-Cell Therapy for Viral Infections of the Central Nervous System: A Review

Multiple drugs

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