Cellular therapy with sequential unmanipulated donor lymphocyte infusions in drug-resistant cytomegalovirus (CMV) encephalitis

Akpek, Görgün; Mikulski, Maria; Kleinberg, Michael; Badros, Ashraf; Yanovich, Saul; Rapoport, Aaron P.

doi:10.1182/blood-2011-02-334060

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…Fourteen cases of CMV-induced central nervous system (CNS) disease have been reported (Table 1) [ [5][6][7][8][9][10][11][12][13][14][15][16][17]. Of published cases including ours, the median time of onset of CMV CNS disease was 185 days (range 107-285 days).…”

Section: Clonal Expansion Of T Cells In the Skin Is The Hallmark Of Cmentioning

confidence: 99%

“…Akpek et al reported that nonspecific U-DLI might possess clinical activity against drug-resistant CMV, possibly resulting from the reactivation and expansion of CMV-specific cytotoxic memory T cells in donor lymphocytes in vivo [15]. CMV-specific cytotoxic T cells are known to prevent development of severe CMV disease after HSCT [29].…”

Section: Clonal Expansion Of T Cells In the Skin Is The Hallmark Of Cmentioning

confidence: 99%

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A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations

et al. 2012

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Abstract:Cytomegalovirus (CMV) infection is latent in the majority of adult humans. The reactivation of CMV causes pneumonia and gastrointestinal disease in severely immunosuppressed patients, who consequently suffer very high mortality due to CMV central nervous system disease. We report here a case involving a 28-year-old female patient with mycosis fungoides who underwent umbilical cord blood transplantation three times and developed CMV ventriculoencephalitis. The patient's CMV viremia was successfully preempted with ganciclovir (GCV) as indicated by undetectable CMV antigenemia, but despite this successful treatment, the patient developed CMV ventriculoencephalitis. Foscarnet (FCV) therapy led to a temporary recovery, after which CMV ventriculoencephalitis recurred and the patient died after receiving combination GCV and FCV therapy. Autopsy samples revealed CMV ventriculoencephalitis, as indicated by numerous inclusion-bearing cells (Owl's eye). It is likely that this patient harbored a GCV-resistant CMV strain; however, it was not possible to obtain nucleic acids suitable for use in assessing this possibility.

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Section: Clonal Expansion Of T Cells In the Skin Is The Hallmark Of Cmentioning

confidence: 99%

Section: Clonal Expansion Of T Cells In the Skin Is The Hallmark Of Cmentioning

confidence: 99%

A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations

et al. 2012

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“…New antiviral drugs [18], vaccines [19,20], and reconstitution of HCMV cellular immunity [21-23] should be considered when designing new models of HCMV disease prevention.…”

Section: Resultsmentioning

confidence: 99%

Differential outcome of neurological HCMV infection in two hematopoietic stem cell transplant recipients

et al. 2012

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BackgroundHuman cytomegalovirus (HCMV) infection of the central nervous system (CNS) is a rare but life threatening condition which may follow hematopoietic stem cell transplantation. Diagnosis, monitoring and treatment approaches rely on anecdotal reports.Case presentationsThe different outcomes of HCMV CNS disease in an adult and a pediatric T-cell depleted hematopoietic stem cell transplant (HSCT) recipient are reported. In the first case, HCMV encephalitis emerged in the context of simultaneous impairment of the T- and B-cell immunity. Antiviral treatment only reduced viral load in peripheral blood and the patient died. In the second case, an HCMV radiculopathy was observed and antiviral treatment was adjusted on the basis of intrathecal drug level. In addition, donor HCMV-specific cytotoxic T lymphocytes (CTLs) were infused. Viral load in the CNS decreased and the patient recovered from the acute event. In neither case were drug-resistant HCMV variants observed in blood or CNS samples.ConclusionsT-cell depleted HSCT appears a predisposing condition for CNS HCMV infection since never observed in other HSCT recipients at our center in the last 15 years. Intensive diagnostic approaches and timely aggressive combination treatments might improve clinical outcome in these patients.

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“…This is often due to either viral resistance or poor tolerance of the pharmacologic antiviral therapy. Anecdotal reports have also shown efficacy of donor lymphocyte infusion in controlling refractory infection . Since these patients suffer severely compromised T cell function, restoring the immune cellular function by adoptive transfer of virus‐specific cytotoxic T cells (CTL) has been attempted in patients with severe refractory viral infection .…”

Section: Virus‐specific Cytotoxic T Cell Therapymentioning

confidence: 99%

Viral infections after allogeneic hematopoietic stem cell transplant

2019

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Viral infections are common causes of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). In particular, allogeneic HSCT induces a profound immunocompromised state that may last up to 24 months post transplant, or longer in case of chronic graft vs host disease (GVHD). The common viruses affecting HSCT patients are HSV, VZV, CMV, EBV, adenovirus, HHV6, BKvirus and upper respiratory viruses such as influenza, parainfluenza, and RSV. These infections typically occur in three distinct phases: pre-engraftment, early postengraftment, and late postengraftment. This review will have two major sections, the first will discuss the epidemiology and natural history of different viral infections and second part will discuss preventive and therapeutic strategies among HSCT patients.

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Cellular therapy with sequential unmanipulated donor lymphocyte infusions in drug-resistant cytomegalovirus (CMV) encephalitis

Cited by 9 publications

References 14 publications

A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations

A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations

Differential outcome of neurological HCMV infection in two hematopoietic stem cell transplant recipients

Viral infections after allogeneic hematopoietic stem cell transplant

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