Cytomegalovirus in hematopoietic stem cell transplant recipients: Current status, known challenges, and future strategies Journal Article
| Authors: | Boeckh, M.; Nichols, W. G.; Papanicolaou, G.; Rubin, R.; Wingard, J. R.; Zaia, J. |
| Article Title: | Cytomegalovirus in hematopoietic stem cell transplant recipients: Current status, known challenges, and future strategies |
| Abstract: | Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after hematopoietic stem cell transplantation. Significant progress has been made in the prevention of CMV disease over the past decade, but prevention of late CMV disease continues to be a challenge in selected high-risk populations. The pretransplantation CMV serostatus of the donor and/or recipient remains an important risk factor for posttransplantation outcome despite the use of antiviral prophylaxis and preemptive therapy; CMV-seropositive recipients of T cell-depleted grafts in particular continue to have a survival disadvantage compared with seronegative recipients with seronegative donors. The risk of developing antiviral drug resistance remains low in most patients; however, in a setting of intense immunosuppression (eg, after transplantation from a haploidentical donor), the incidence may be as high as 8%. Primary CMV infection via blood transfusion can be reduced by the provision of seronegative or leukocyte-depleted blood products; however, a small risk of 1% to 2% of CMV disease remains. Surveillance and preemptive therapy are effective in preventing the sequelae of transfusion-related CMV infection. Indirect immunomodulatory effects of CMV are increasingly recognized in hematopoietic stem cell transplant recipients. Strategies currently being investigated include long-term suppression of CMV with valganciclovir for the prevention of late CMV infection and disease, adoptive transfer of CMV-specific T cells, and donor and recipient vaccination strategies. © 2003 American Society for Blood and Marrow Transplantation. |
| Keywords: | busulfan; fludarabine; clinical trial; mortality; neutropenia; review; placebo; dose response; drug efficacy; drug megadose; cd8 antigen; t lymphocyte; cd34 antigen; nephrotoxicity; incidence; morbidity; aciclovir; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; transplantation; risk factor; thiotepa; cell specificity; donor; immunotherapy; prophylaxis; vaccination; blood transfusion; graft versus host reaction; transplantation conditioning; herpes virus; adoptive transfer; immunomodulation; antivirus agent; cidofovir; drug bioavailability; hematopoietic stem cell; drug absorption; high risk population; graft survival; cd4 antigen; corticosteroid; immunosuppressive treatment; graft vs host disease; mycophenolic acid 2 morpholinoethyl ester; antigens, cd34; glycoprotein; foscarnet; ganciclovir; cytomegalovirus infection; meta analysis; infection risk; lymphocyte depletion; alemtuzumab; immunosuppressive agent; bone marrow disease; resistance; acyclovir; thymocyte antibody; immunosuppression; antiviral agents; organophosphorus compounds; valganciclovir; immunoglobulins, intravenous; recipient; cytosine; valaciclovir; cmv; cytomegalovirus infections; phosphonic acids; humans; human |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 9 |
| Issue: | 9 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2003-09-01 |
| Start Page: | 543 |
| End Page: | 558 |
| Language: | English |
| DOI: | 10.1016/s1083-8791(03)00287-8 |
| PUBMED: | 14506657 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 25 September 2014 -- Source: Scopus |
