Vol 54, No 3 (2023)
Editorial
Published online: 2023-06-11

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Revolution in management of CMV infection after hematopoietic cell transplantation

Jan Styczyński1
Acta Haematol Pol 2023;54(3):111-112.

Abstract

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EDITORIAL

Acta Haematologica Polonica 2023

Number 3, Volume 54, pages 111–112

DOI: 10.5603/AHP.a2023.0034

ISSN 0001–5814

e-ISSN 2300–7117

Revolution in management of CMV infection after hematopoietic cell transplantation

Jan Styczyński
Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Toruń, Jurasz University Hospital 1, Bydgoszcz, Poland

Received: 27.05.2023 Accepted: 27.05.2023 Early publication date: 11.06.2023

Address for correspondence: Jan Styczyński, Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85–094 Bydgoszcz, Poland, phone +48 52 58 54 860, fax +48 52 58 54 087, e-mail: jstyczynski@cm.umk.pl

Cytomegalovirus (CMV) infection is a major complication after allogeneic hematopoietic cell transplantation (allo-HCT), and a serious trigger for other sequelae [1–3]. The introduction of letermovir into the prophylaxis of CMV infection has led to a large reduction of the CMV reactivation rate in seropositive adult patients after allo-HCT [4–5]. This effect obviously means fewer direct and indirect complications caused by the virus [6–8]. Successful prophylaxis alleviates the negative impact of recipient CMV-seropositivity and eventually results in lower non-relapse mortality and better overall survival [4, 5, 9].

Progress is still being maintained. Recent trials have shown the safety and efficacy of letermovir use for prolonged (200 days) prophylaxis, and also in other patient populations such as children, as well as in secondary prophylaxis [10].

Yet another new anti-CMV drug, maribavir, is in the pipeline. This antiviral has been shown to have efficacy in preemptive treatment and in resistant CMV infections [1]. Fortunately, both letermovir and maribavir have very beneficial safety profiles, unlike the old-generation anti-CMV antivirals. Interestingly, during the most recent Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), half of the highest-scoring abstracts on infectious complications were dedicated to the topic of CMV, confirming that this is one of the most pressing issues in the current management of allo-HCT.

The coronavirus disease 2019 (COVID-19) pandemic is over, as announced by the World Health Organization (WHO) on 5 May. CMV infection after allo-HCT is not over, but, with new antivirals, it can be vastly reduced. The next step must be to find an effective vaccine against CMV. With the new mRNA technologies used for the anti-SARS-CoV-2 vaccine, hopes are high that transplant patients will finally be able to overcome the problem of CMV.

Authors’ contributions

JS — sole author.

Conflict of interest

The author declares no conflict of interest.

Financial support

None.

Ethics

The work described in this article has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans; EU Directive 2010/63/EU for animal experiments; Uniform requirements for manuscripts submitted to biomedical journals.

References

  1. Włodarczyk M, Helbig G. How to manage cytomegalovirus reactivation/infection after hematopoietic stem cell transplantation: practical tips for clinicians. Acta Haematol Pol. 2023; 54(3): 129–137, doi: 10.5603/AHP.a2023.0028.
  2. Styczynski J, Gałązka P, Czyżewski K, et al. High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: the adverse role of post-transplant CMV replication. Acta Haematol Pol. 2021; 52(5): 483–492, doi: 10.5603/AHP.a2021.0025.
  3. Gil L. Cytomegalovirus and invasive fungal disease: trolls of hematopoietic cell transplantation. Acta Haematol Pol. 2021; 52(5): 453– –454, doi: 10.5603/AHP.2021.0086.
  4. Marty FM, Ljungman P, Chemaly RF, et al. Letermovir prophylaxis for cytomegalovirus in hematopoietic-cell transplantation. N Engl J Med. 2017; 377(25): 2433–2444, doi: 10.1056/NEJMoa1706640, indexed in Pubmed: 29211658.
  5. Łojko A, Styczyński J, Nasiłowska-Adamska B, et al. Real-life experiences of letermovir prophylaxis for cytomegalovirus infection in patients after hematopoietic stem cell transplantation: Polish Acute Leukemia Group (PALG) analysis. Acta Haematol Pol. 2022; 53(5): 350–354, doi: 10.5603/AHP.a2022.2047.
  6. Styczyński J, Czyżewski K, Ussowicz M, et al. Protective environment in hematopoietic cell transplantation centers: results of a survey of the Polish Federation of Bone Marrow Transplant Centers. Acta Haematol Pol. 2021; 52(2): 127–131, doi: 10.5603/AHP.2021.0019.
  7. Giebel S, Basak G, Bieniaszewska M, et al. Current status and achievements of Polish haemato-oncology. Acta Haematol Pol. 2021; 52(1): 4–17, doi: 10.5603/AHP.2021.0003.
  8. Styczynski J, Piekarska A, Zaucha-Prażmo A, et al. Antimicrobial prophylaxis in adults and children undergoing hematopoietic cell transplantation: 2021 Polish recommendations. Acta Haematol Pol. 2021; 52(6): 528–542, doi: 10.5603/ahp.a2021.0097.
  9. Snowden JA, Styczyński J, Snarski E, et al. Hematopoietic stem cell transplantation in autoimmune diseases: update from EBMT Autoimmune Diseases Working Party with special reference to Poland. Acta Haematol Pol. 2021; 52(4): 217–224, doi: 10.5603/ahp.2021.0043.
  10. Styczyński T, Sadlok J, Richert-Przygońska M, et al. Letermovir use in children after hematopoietic cell transplantation: summary of reported data. Acta Haematol Pol. 2023; 54(1): 31–35, doi: 10.5603/AHP.a2023.0004.