Cytomegalovirus Immune reconstitution in cord blood transplant recipients on letermovir prophylaxis.

Autor: Abidi MZ; Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA., Molina KC; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.; Department of Pharmacy, Scripps Green Hospital, La Jolla, California, USA., Garth K; Department of Pediatrics, Division of Infectious Diseases, University of Colorado, Denver, Colorado, USA., Gutman JA; Department of Hematology/Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA., Weinberg A; Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA.; Department of Pediatrics, Division of Infectious Diseases, University of Colorado, Denver, Colorado, USA.; Department of Pathology, University of Colorado, Aurora, Colorado, USA.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2023 Oct; Vol. 25 (5), pp. e14104. Date of Electronic Publication: 2023 Jul 12.
DOI: 10.1111/tid.14104
Abstrakt: Introduction: Cytomegalovirus (CMV) can cause significant morbidity and mortality in cord blood transplant (CBT) recipients. Development of CMV-specific cell-mediated immunity (CMV-CMI) has been associated with protection against CMV clinically significant reactivation (CsCMV). In this study, we evaluated CMV-CMI reconstitution during letermovir prophylactic therapy, which prevents CsCMV without complete suppression of CMV reactivation.
Methods: We measured CMV-CMI in CMV-seropositive CBT recipients pre-transplant after Day+90 of letermovir prophylaxis and at Days +180, and +360- post-transplant using a dual color CMV-specific IFNγ/IL2 FLUOROSpot. CsCMV and nonCsCMV reactivations were abstracted from medical records. CsCMV was defined as CMV viral load ≥5,000 IU/ml using a whole blood assay.
Results: Among 70 CBT recipients, 31 developed CMV-CMI by Day+90 and an additional eight and five participants by Days +180 and +360, respectively. Thirty-eight participants developed CMV reactivation, including nine with CsCMV. Most reactivations (33 of 38) occurred before Day+180. Early CMV-CMI was present in six out of nine participants with CsCMV, indicating a lack of protection against CsCMV. Moreover, the magnitude of CMV-CMI at Day+90 did not differ between participants with CsCMV and nonCsCMV.
Conclusion: Approximately 50% of CBT recipients reconstituted CMV-CMI during letermovir prophylactic therapy. However, CMV-CMI did not reach levels protective against CsCMV. Extension of CMV prophylaxis beyond Day+90 may be considered in CMV-seropositive CBT recipients.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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