Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands.
Biol Blood Marrow Transplant. 2018 Sep;24(9):1776-1782. doi: 10.1016/j.bbmt.2018.03.028. Epub 2018 Apr 4.
Recipients of allogeneic stem cell transplantation (alloSCT) are at risk for reactivation of endogenous herpesviruses due to profound and prolonged T cell deficiency following conditions such as graft-versus-host disease, immunosuppression, and/or T cell depletion. Reactivation of endogenous cytomegalovirus (CMV) is the most frequently occurring herpesvirus reactivation following alloSCT. Antiviral medication is often used in pre-emptive treatment strategies initiated when increases in CMV viral loads are detected as a result of active reactivation of the virus. Despite pre-emptive antiviral treatment, the incidence of CMV disease in CMV-seropositive alloSCT patients is still 10% at 1 year following alloSCT. This illustrates the necessity for adequate CMV-specific T cell immunity for long-term control of CMV and prevention of CMV disease. In this review, we analyzed the available studies on the influence of donor CMV status on CMV-specific T cell reconstitution and CMV disease. Furthermore, we reviewed the available studies on the safety and efficacy of adoptive transfer of donor CMV-specific T cells for the prevention and treatment of CMV disease following alloSCT, including studies on adoptive transfer of third-party CMV-specific T cells as a possible alternative when donor T cells are not available.
异基因造血干细胞移植（alloSCT）受者由于移植物抗宿主病、免疫抑制和/或 T 细胞耗竭等原因，存在内源性疱疹病毒再激活的风险，T 细胞严重和长期缺乏。alloSCT 后，内源性巨细胞病毒（CMV）再激活是最常见的疱疹病毒再激活。抗病毒药物常被用于抢先治疗策略中，当病毒活性再激活导致 CMV 病毒载量增加时，启动该策略。尽管进行了抢先抗病毒治疗，CMV 阳性 alloSCT 患者在 alloSCT 后 1 年的 CMV 疾病发生率仍为 10%。这表明需要足够的 CMV 特异性 T 细胞免疫来长期控制 CMV 并预防 CMV 疾病。在这篇综述中，我们分析了关于供体 CMV 状态对 CMV 特异性 T 细胞重建和 CMV 疾病的影响的现有研究。此外，我们还综述了关于同种异体造血干细胞移植后使用供体 CMV 特异性 T 细胞进行预防和治疗 CMV 疾病的现有研究，包括当供体 T 细胞不可用时，使用第三方 CMV 特异性 T 细胞进行过继转移的安全性和有效性研究。
