Cytomegalovirus: time for a requiem?

摘要

I remember cytomegalovirus (CMV) as a scourge that competed with relapse as the top cause of death after allogeneic bone marrow transplantation. Although ganciclovir eliminated CMV as a significant cause of mortality after hematopoietic stem cell transplantation (HSCT), neutropenia associated with its prolonged administration-whether prophylactic (before infection) or preemptive (after infection, but before the development of CMV disease)-increased bacterial and fungal infections, thereby blunting its beneficial impact on survival. Prolonged ganciclovir administration also delayed reconstitution of CMV-specific cell-mediated immunity, contributing to late infections after therapy was discontinued. However, a short 3-week course of preemptive ganciclovir was found to be effective in treating cytomegaloviremia without increasing other infections or causing frequent episodes of repeat viremia. Such preemptive short-course ganciclovir therapy (or its oral prodrug, valganciclovir) has become the gold-standard approach to CMV infection, and arguably is one of the few factors to have improved survival after allogeneic SCT over the last 15 years