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Resistant or refractory cytomegalovirus infections after hematopoietic cell transplantation

diagnosis and management

Khawaja, Fareed; Batista, Marjorie V.; El Haddad, Lynn; Chemaly, Roy F.

Current Opinion in Infectious Diseases: December 2019 - Volume 32 - Issue 6 - p 565–574
doi: 10.1097/QCO.0000000000000607
ANTIMICROBIAL AGENTS: VIRAL: Edited by Roy F. Chemaly
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Purpose of review Refractory or resistant cytomegalovirus (CMV) infections are challenging complications after hematopoietic cell transplantation (HCT). Most refractory or resistant CMV infections are associated with poor outcomes and increased mortality. Prompt recognition of resistant or refractory CMV infections, understanding the resistance pathways, and the treatment options in HCT recipients are imperative.

Recent findings New definitions for refractory and resistant CMV infections in HCT recipients have been introduced for future clinical trials. Interestingly, refractory CMV infections are more commonly encountered in HCT recipients when compared with resistant CMV infections. CMV terminase complex mutations in UL56, UL89, and UL51 could be associated with letermovir resistance; specific mutations in UL56 are the most commonly encountered in clinical practice. Finally, brincidofovir, maribavir, letermovir, and CMV-specific cytotoxic T-cell therapy expanded our treatment options for refractory or resistant CMV infections.

Summary Many advances have been made to optimize future clinical trials for management of refractory or resistant CMV infections, and to better understand new resistance mechanisms to novel drugs. New drugs or strategies with limited toxicities are needed to improve outcomes of difficult to treat CMV infections in HCT recipients.

Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence to Roy F. Chemaly, MD, MPH, Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030-4095, USA. Tel: +1 713 745 1116; e-mail: rfchemaly@mdanderson.org

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