Immunothérapie adoptive antivirale après allogreffe de cellules souches hématopoïétiques

Viral infections represent one of the main causes of morbidity and mortality following hematopoietic stem cell transplantation. Antiviral treatment failure may be explained by the absence of specific immune reconstitution. In the 1990s, antiviral immunotherapy initially consisting in total donor lymphocyte infusion presented efficiency but was often associated with adverse events. Specific antiviral immunotherapy emerged and relied on the isolation of mono- or multivirus donor-derived-specific T cells with or without in vitro expansion. During the last 10 years, such an adoptive transfer has been proved feasible, and helpful in specific antiviral immune reconstitution, and rarely associated with adverse events. Two main evolutions contributed to allow a good reactivity to propose immunotherapy in case of antiviral treatment failure: the development of allogeneic cytotoxic T lymphocytes (CTL) banks and the improvement of CTL isolation methods using immunomagnetic technology, which presents the advantage to be fast.