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Immunovirology of cytomegalovirus infection in allogeneic stem cell transplant recipients undergoing prophylaxis with letermovir: A narrative review

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Immunovirology of cytomegalovirus infection in allogeneic stem cell transplant recipients undergoing prophylaxis with letermovir: A narrative review

dc.contributor.author	Solano Vercet, Carlos
dc.contributor.author	Giménez, Estela
dc.contributor.author	Albert, Eliseo
dc.contributor.author	Piñana, José Luis
dc.contributor.author	Navarro, David
dc.date.accessioned	2023-09-12T07:53:15Z
dc.date.available	2023-09-12T07:53:15Z
dc.date.issued	2023
dc.identifier.citation	Solano Vercet, Carlos Giménez, Estela Albert, Eliseo Piñana, José Luis Navarro, David 2023 Immunovirology of cytomegalovirus infection in allogeneic stem cell transplant recipients undergoing prophylaxis with letermovir: A narrative review Journal of Medical Virology 95 8
dc.identifier.uri	https://hdl.handle.net/10550/89212
dc.description.abstract	On November 7, 2017, the US Food and Drug Administration approved the use of letermovir (LMV) for prophylaxis of cytomegalovirus (CMV) infection in adult CMV-seropositive allogeneic stem cell transplant recipients. After 6 years of use, a large body of real-world experience has been accumulated that validates the Phase III clinical trial results, in which LMV was shown to significantly reduce the risk of clinically significant CMV infection¿defined as CMV end-organ disease or CMV DNAemia requiring pre-emptive antiviral therapy (PET) and increase survival up to Week 24 after treatment inception. Notwithstanding, several issues still need to be settled, thus further investigation is required. First, since viral DNA may accumulate as a result of LMV-driven abortive CMV infection, what is the optimal viral load threshold in the blood that would prompt LMV prophylaxis interruption and PET inception? Should this be adapted to the patient's risk? Second, what is the impact of LMV prophylaxis on the reconstitution of functional CMV-specific T-cell responses? Would it be a wise approach to individually tailor the duration of LMV treatment according to the number of peripheral blood CMV-specific T cells at the end of regular prophylaxis? Third, how frequently do LMV-resistant strains arise while patients are on LMV prophylaxis and how could this be minimized? Here, we discuss the literature addressing these topics.
dc.language.iso	eng
dc.relation.ispartof	Journal of Medical Virology, 2023, vol. 95, num. 8
dc.subject	Microbiologia
dc.subject	Patologia
dc.title	Immunovirology of cytomegalovirus infection in allogeneic stem cell transplant recipients undergoing prophylaxis with letermovir: A narrative review
dc.type	journal article
dc.date.updated	2023-09-12T07:53:15Z
dc.identifier.doi	10.1002/jmv.29005
dc.identifier.idgrec	161154
dc.rights.accessRights	open access