Novel Approaches to CMV After HCT: Report from the 27th European Congress of Clinical Microbiology and Infectious Diseases, Vienna, Austria, 22–25 April 2017

Triple RNA-Seq Reveals Synergy in a Human Virus-Fungus Co-infection Model

“…In addition, human cytomegalovirus (CMV)-associated infections, including CMV pneumonia, remain the most common infectious complications in alloSCT recipients (Camargo and Komanduri, 2017), and CMV viremia is associated with increased early overall mortality after alloSCT (Green et al, 2016). CMV-disease-related mortality has significantly declined with improved prophylactic medication, PCR-based diagnostics, and pre-emptive antiviral treatment, yet indirect CMV effects continue to adversely impact alloSCT outcomes (de la Cá mara, 2016; Duarte and Lyon, 2018). Notably, CMV infections pose an independent risk factor for development of IA in alloSCT recipients (Garcia-Vidal et al, 2008;Marr et al, 2002), and invasive mycoses are a frequent cause of mortality in patients surviving CMV disease (de la Cá mara, 2016; Nichols et al, 2002).…”

Ganciclovir in the Prevention of Cytomegalovirus Reactivation in Allogeneic Hematopoietic Stem Cell Transplantation: Non-Eliminative Reduction of Viral Load

“…Graft versus leukemia/lymphoma/myeloma effect may be desired in refractory disease. The immunological interaction of graft and host mainly proceeds on T cell mediated immunity, and the entrance of reactivation of a latent CMV may alter the balance leading to increased rates of GVHD, as well as bacterial or fungal infections and both CMV-related or unrelated mortality (5)(6)(7). Primary or secondary prophylaxy, pre-emptive treatment with antivirals, specific and nonspecific immunoglobulins, and adoptive specific T cell transfer therapies are reported with conflicting outcomes (7,10).…”

“…In contrast, in seronegative recipients with a seropositive donor, the risk of primary infection is reported as 30%. Besides the serologic status of the HCT recipient, corticosteroid treatment, T cell depletion with either purine analogues or Alemtuzumab, development of graft versus host disease (GVHD), and the graft source are also suggested as risk factors (5)(6)(7).…”

“…The diagnosis of CMV disease is challenging in HCT recipients due to the clinical signs and symptoms, which may be confused with graft rejection and infections due to other microorganisms. For this diagnostic challenge, it is suggested that every donor and recipient should be surveyed for CMV seropositivity before HCT with a risk estimation of reactivation and later monitored regularly with polymerase chain reaction (PCR) assay (7).…”

“…Myelosuppression is frequently observed in patients receiving ganciclovir. Novel agents, including Brincidofovir, Maribavir, and Letermovir are currently being under investigation with promising results (7).…”