Combination therapy for multidrug-resistant cytomegalovirus disease

Area of Science:

• Infectious Diseases
• Transplantation Immunology
• Virology

Background:

• Allogeneic hematopoietic stem cell transplantation (HSCT) carries a risk of cytomegalovirus (CMV) reactivation.
• Ganciclovir, foscarnet, and cidofovir are standard antiviral treatments for CMV infections.

Observation:

• A CMV-seropositive recipient of HSCT from a CMV-seronegative donor developed multidrug-resistant (MDR) CMV.
• Initial treatments with ganciclovir, foscarnet, and cidofovir provided only transient responses.
• Experimental therapies with leflunomide and artesunate were unsuccessful.

Findings:

• A successful treatment regimen involved re-transplantation from a CMV-seropositive donor.
• This was combined with adoptive transfer of pp65-specific T cells.
• The addition of maribavir led to lasting suppression of MDR CMV.

Implications:

• MDR CMV infections post-HSCT pose significant therapeutic challenges.
• Individualized, multidisciplinary treatment strategies are crucial for managing complex cases.
• Novel therapeutic combinations may be required for effective MDR CMV control.