Management of cytomegalovirus in hematopoietic stem cell transplant recipients: A review of novel pharmacologic and cellular therapies

Background: Despite diagnostic and therapeutic advances, cytomegalovirus (CMV) infection has remained a significant complication after hematopoietic stem cell transplantation (HSCT). The widespread use of pre-emptive antiviral therapy has reduced, but not eliminated, the occurrence of early CMV infection. The epidemiological shift of CMV infection, requiring repeated and prolonged treatment courses, creates an increasing need for novel antiviral drugs. This is an exciting time in the evolution of pharmacologic anti-CMV therapies. Objective: This review article provides an update on the therapeutic options for treatment of CMV in HSCT recipients, focusing on new pharmacologic agents—including maribavir, letermovir, brincidofovir, leflunomide, and artesunate—as well on as the emerging concept of cellular therapies and the future of a CMV vaccine. Results: In the past few years, encouraging preliminary data has emerged for both new pharmacologic therapies and cellular therapies; however, current evidence does not support their routine use for CMV prophylaxis or treatment. Conclusions: Despite the lack of data substantiating the routine use of new pharmacologic and cellular therapies, numerous trials, many of which are either phase III or randomized, are currently underway and will undoubtedly influence the use of these agents in the near future. CMV vaccines offer a safe and effective alternative to pharmacologic and cellular therapies as we await results of phase III clinical trials.