Onkológia 2/2024

Prevention of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

Cytomegalovirus (CMV) infection remains a frequent complication after allogeneic hematopoietic stem cell transplantation (alloHSCT) which can lead to serious CMV end - organ disease and causes significant morbidity and mortality in transplant recipients. CMV reactivation is common after alloHSCT during the time of T cell deficiency or dysfunction and can increase risk of transplantation failure and non - relapse mortality (NRM). Pre - transplant donor / recipient CMV serological status is the main risk factor influencing the incidence and mortality of CMV disease after transplantation. Proper selection of donor and recipient, regular monitoring of viremia, an early intervention in CMV reactivation and rapid and effective treatment when the disease develops, remain crucial to decrease the risk od post-transplant CMV reactivation / disease. The two major strategies for CMV prevention are prophylaxis and preemptive therapy (PET) with initiation of antiviral treatment upon detection of viral replication. However, antiviral agents (ganciclovir, valganciclovir or foscarnet) used in PET are associated with significant adverse effects such a myelo- or nephrotoxicity, precluding their routine use for CMV prophylaxis. The approval of the novel anti - CMV drug letermovir (LMV) in 2017 has led to an increase in the use of antiviral prophylaxis as a preferred approach for CMV prevention in many centers. LMV for CMV primary prophylaxis in CMV - seropositive adult recipients of HSCT (for up to 100 days following alloHSCT) reduced the incidence of CMV - related complications, the use of PET with anti - CMV agents that are associated with severe adverse events and may have prevented the direct and indirect effects of CMV infections. Extending the duration of LMV prophylaxis to 200 days following alloHSCT is efficacious and safe in patients who remain at risk of late clinically significant CMV infection.

Keywords: cytomegalovirus infection, risk factors, diagnostics, preemptive therapy, primary prophylaxis, letermovir