Incidence and dynamics of active cytomegalovirus infection in allogeneic stem cell transplant patients according to single nucleotide polymorphisms in donor and recipient CCR5, MCP-1, IL-10, and TLR9 genes

2014 ◽  
Vol 87 (2) ◽  
pp. 248-255 ◽  
Author(s):  
Isabel Corrales ◽  
Estela Giménez ◽  
Carlos Solano ◽  
Paula Amat ◽  
Rafael de la Cámara ◽  
...  
Keyword(s):  
Stem Cell ◽  
Single Nucleotide Polymorphisms ◽  
Cytomegalovirus Infection ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Nucleotide Polymorphisms ◽  
Allogeneic Stem Cell Transplant ◽  
Single Nucleotide ◽  
Transplant Patients

scholarly journals Letermovir profilaxis allogén vérképző-őssejt transzplantációban: egy hazai centrum gyakorlati tapasztalatai

2021 ◽  
Vol 54 (3) ◽  
pp. 153-157
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Cytomegalovirus Infection ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Antiviral Compound ◽  
Transplant Patients

Összefoglaló. Bevezetés: A humán cytomegalovírus infekció direkt és indirekt szövődményei napjainkban is veszélyeztetik az allogén őssejt-transzplantációval kezelt betegeket. A széles körben alkalmazott preemptív stratégia mellett előnyös lehet a kórokozó reaktivációjának megelőzése profilaktikusan adagolt vírusellenes vegyülettel. A letermovir innovatív hatásmechanizmusú, szűk spektrumú antivirális szer, mely allogén őssejt-transzplantáltak körében végzett, placebo kontrollált klinikai vizsgálatban csökkentette a cytomegalovírus infekciók gyakoriságát és javította a túlélést. A szerzők 23, allogén őssejt-transzplantált beteg retrospektív módon gyűjtött adatait ismertetik, akik a beavatkozás kapcsán letermovir profilaxisban részesültek. A betegek több mint fele akut leukémiában szenvedett, harmaduk aktív betegséggel került transzplantációra, kétharmaduk donora haploidentikus egyezést mutatott. A letermovir adagolása során 2, azt követően további 3 személyben lépett fel cytomegalovírus infekció. Szervi érintettséggel járó cytomegalovírus betegség egyetlen esetben sem alakult ki. A megfigyelési időszak során 2 fő hunyt el, cytomegalovírustól független okok miatt. Az alkalmazhatóságot korlátozó mellékhatást nem észleltek. A letermovir a mindennapi klinikai gyakorlatban is hatékonynak és biztonságosnak bizonyult az őssejt-transzplantáltak cytomegalovírus fertőzésének megelőzésére. Summary. Introduction: Direct and indirect effects of cytomegalovirus infection remain an ongoing threat to patients treated with allogeneic stem cell transplantation. In addition to the widely used preemptive approach, prevention of viral replication with a prophylactically administered antiviral drug seems to be feasible. Letermovir, a narrow-spectrum antiviral compound with an innovative mechanism of action, has been shown to decrease the incidence of cytomegalovirus infection and to improve survival in a placebo-controlled clinical trial recruiting allogeneic stem cell transplant patients. Authors present retrospectively collected data from 23 patients receiving letermovir prophylaxis as a part of their allogeneic stem cell transplantation procedure. More than half of prophylaxed individuals had acute leukemia, a third of them underwent transplantation with an active disease and two third of the cohort had a haploidentical donor. During prophylaxis 2, subsequently further 3 patients developed a cytomegalovirus infection. No organ-specific disease could be detected. Through the observational period 2 patients have died due to causes unrelated to cytomegalovirus. No side effect interfering with drug use could be revealed. In this real-life case series letermovir has been shown to be effective and safe for the prevention of cytomegalovirus infection in allogeneic stem cell transplant patients.

Leflunomide therapy for refractory cytomegalovirus infections in hematopoietic stem cell transplant recipients

2018 ◽  
Vol 25 (7) ◽  
pp. 1731-1737 ◽  
Author(s):  
Emily Wang ◽  
Anna S Jan ◽  
Vi P Doan ◽  
Jill B Ferguson ◽  
Jason C Yeh
Keyword(s):  
Stem Cell ◽  
Patient Population ◽  
Cytomegalovirus Infection ◽  
Transplant Patient ◽  
Stem Cell Transplant ◽  
Case Series ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Transplant Patients ◽  
Cytomegalovirus Infections

Background Currently, there are no prospective, randomized trials analyzing leflunomide for the treatment of cytomegalovirus infection or disease in allogeneic stem cell transplant patients. Objective The primary objective of this case series was to determine the clinical and virological responses of utilizing leflunomide as therapy for refractory cytomegalovirus infections, unresponsive to first-line therapy in allogeneic stem cell transplant patients. Additionally, patient and leflunomide specific characteristics were identified and determined in this descriptive case series. Methods This is a single-center, case series of adult allogeneic stem cell transplant patients with refractory cytomegalovirus infections receiving leflunomide between 1 January 2005 and 31 March 2015. Results A total of 14 patients with refractory cytomegalovirus infections received leflunomide. All patients received concurrent anti-cytomegalovirus therapy. Nine of 13 patients tested positive for phosphotransferase UL97 and/or viral DNA polymerase UL54 genotype mutations. Nine patients achieved a virological response with undetectable cytomegalovirus titers. Of the 13 patients with teriflunomide serum levels, eight patients maintained levels >40 micrograms/milliliter (mcg/mL). Common adverse effects were pancytopenia (n = 8) and elevated liver function tests (n = 4). Conclusions Despite current strategies, refractory or recurrent cytomegalovirus infection and disease remain a clinical challenge to treat in the stem cell transplant patient population. Leflunomide used in combination with other concomitant therapies use for refractory cytomegalovirus infection in clinical practice may be a safe and effective option in the allogeneic stem cell transplant patient population.

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