Adoptive immunotherapy with antigen specific cytotoxic T lymphocytes (CTL) has been shown to be effective in restoring cellular immunity to cytomegalovirus (CMV) and preventing viral reactivation following allogeneic stem cell transplantation (SCT). In order to develop a cost-effective, relatively rapid method of CMV CTL expansion, we investigated the use of a pool of overlapping CMV peptides. Since the possibility exists of vaccinating CMV sero-negative donors, and these individuals may have T cell responses predominantly against IE-1, commercially available peptide mixes for pp65 as well as IE-1 were used to stimulate CTL from ten sero-positive donors. In four of these ten donors, responses were present to pp65 only, one donor did not respond to pp65 or IE-1, four donors responded to both pp65 and IE-1, and one donor to IE-1 only. These CMV specific T cells included a mixture of CD4+ and CD8+ effectors, and specific cytotoxicity correlated with IFN-γ production. The costs associated with a 28 day maintenance course of intravenous ganciclovir, cidofovir, foscarnet, and valganciclovir, as well as the preparation and shipping a single dose of CTL, were determined. The price of generating CMV CTL using this method was comparable to or less expensive than a 28-day maintenance course for these agents, not including the costs associated with drug administration, supportive care, and the treatment of drug-related complications. Considering the relative ease, low cost, and the fact that CTL administration can result in CMV specific immune reconstitution, this option should be considered for patients with CMV reactivation, or for prophylaxis in patients at high risk for infection.

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