EBMT 2022 | CMV infection monitoring after alloHSCT
Raffaella Greco, MD, PhD, San Raffaele Hospital, Milan, Italy, discusses cytomegalovirus (CMV) immune monitoring following allogeneic hematopoietic stem cell transplantation (alloHSCT). In recent years, new innovative drugs such as letermovir and maribavir have been introduced to prevent CMV infection. Studies have shown that letermovir is effective in reducing the risk of CMV infection in the first three months following transplantation, which underlines the importance of monitoring the immune response to CMV after this period. According to Dr Greco, understanding and measuring CMV-specific T-cell immunity can help us improve the clinical management of CMV infection by better stratifying patients into different risk groups, identifying patients at risk of CMV reactivation, and determining the duration of CMV prophylaxis. Dr Greco highlights the importance of harmonizing and standardizing the protocols and tools used for the immune monitoring of CMV infection after transplantation. This interview took place at the 48th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2022, which was held virtually.
Transcript (edited for clarity)
This year and in the last five years, I think we can state that we are already facing a new era for the CMV infection and the reactivation and disease for allogeneic transplant recipients. I think that this can be mainly related to some innovative drugs we have at our disposal now. For example, regarding the prophylaxis with letermovir, but also new drugs that are coming for the preemptive treatment and therapeutic strategies for resistant cases like maribavir, for example...
This year and in the last five years, I think we can state that we are already facing a new era for the CMV infection and the reactivation and disease for allogeneic transplant recipients. I think that this can be mainly related to some innovative drugs we have at our disposal now. For example, regarding the prophylaxis with letermovir, but also new drugs that are coming for the preemptive treatment and therapeutic strategies for resistant cases like maribavir, for example. So we are really facing a new era for that. And also in that context, I think it is important, as I have also presented during the EBMT meeting this year on the Cell Therapy day, the contribution that immune monitoring for specific CMV T-cells after the transplant can give because, for example, we have seen in my presentation that post-transplant cyclophosphamide as GvHD prophylaxis, not only post-transplant, but also with all the other sources, is related to a higher rate of a viral infection, mainly CMV.
In that context, prophylaxis with letermovir is undoubtedly able to reduce, in the first three months after transplantation the rate of CMV infection and disease. But we have seen also that this seems to postpone, after these three months, the risk of CMV in our patient. So we also now have to consider the risk for CMV infection after the first three months after the transplant in our patient. In that context, it is important to underline that CMV specific T-cell immunity may really improve our clinical management. And I am really expecting it to have more use in our clinical practice in the future. It can help also to improve the risk of stratification for our patient and to identify patients at major risk for CMV disease and also for subsequent CMV re-activation, and also can be a really important additional tool for managing transplant recipients at risk for CMV re-activation.
For example, specific CMV immunity measured after the transplant can help us to guide the duration and intensity of CMV viremia monitoring. So the surveillance of the virus after the transplant, because now we have some guidelines also giving more surveillance in the first three months after the transplant, but we can adapt with also the information regarding immuno-constitution when stopping the prophylaxis and what cases we need to monitor carefully also after the first three months. For example, the CMV immunity is able also to adapt the duration of CMV specific prophylaxis because at some stage three months is not sufficient to completely cover our patient from the risk of re-activation, because letermovir seems to delay also the immune constitution of our patient from the first data we have. And also the CMV immunity measured after the transplant can really help us also in the management of the preemptive treatment and the decision of which time point to stop and also the duration.
However, I think that, as I mentioned, and during the EBMT Cell Therapy day, it is important that we also underline for the future, the open issues that we now have, and it’s the type of assay we should use to measure the CMV specific immunity after the transplant, which are the best time points after the transplantation that we should use. And also we really need our monetization and standardization of our immune monitoring protocols after transplant among the EBMT centers.
Read more...
