Case report:Maribavir for refractory CMV infection in 2 pediatric HSCT recipients

Cytomegalovirus (CMV) infection is one of the most prevalent severe complications post hematopoietic stem cell transplantation (HSCT), which significantly increases the morbidity and mortality risks among transplant recipients. Despite the continuous advancement of prevention and treatment strategies for CMV infection, refractory CMV infection remains a major clinical challenge in diagnosis and treatment, and this issue is even more prominent in pediatric patients due to the limited therapeutic options available. This paper reports the diagnosis and treatment of two pediatric cases with refractory CMV infection after HSCT. In Case 1, the child exhibited concurrent activation of CMV and Epstein-Barr virus (EBV) during the early post-transplant period, accompanied by severe hepatic impairment secondary to hepatic veno-occlusive disease. Salvage therapy with maribavir was administered following the ineffectiveness of ganciclovir, foscarnet and cellular immunotherapy, achieving effective control of the patient's condition. In Case 2, the child showed a poor response to monotherapy with ganciclovir and foscarnet, and subsequently progressed to CMV encephalitis. When conventional antiviral therapy failed and intolerable adverse reactions occurred, salvage therapy with a combination of maribavir and foscarnet was given, leading to a favorable clinical outcome. No definite adverse events associated with maribavir were observed in either of the two children during the treatment course. This study suggests that maribavir has potential therapeutic efficacy and favorable tolerability in the short-term clinical management of refractory CMV infection in pediatric patients post-HSCT, while its clinical application value in this population still needs to be further verified by studies with larger sample sizes.