Katayama Yuta, Iwato Koji
Division of Hematology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital.
Division of Clinical Laboratory, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital.
Rinsho Ketsueki. 2019;60(6):635-645. doi: 10.11406/rinketsu.60.635.
In patients who undergo hematopoietic stem cell transplantation (HSCT), cytomegalovirus (CMV) infection directly or indirectly increases all-cause and non-relapse mortality rates. Although preemptive therapy suppresses CMV infection, it does not improve non-relapse mortality rates in patients with CMV reactivation compared to patients with no CMV reactivation. According to the World Health Organization International Standards (WHO IS), quantitative polymerase chain reaction has been recently adopted as the global standard for monitoring CMV, and maribavir, brincidofovir, and letermovir have been developed as new antiviral drugs for the treatment of CMV infection. Letermovir, a first-class anti-CMV agent, strongly inhibits the CMV DNA terminase complex, which is required for viral DNA cleavage and packaging. It significantly suppressed CMV infection in a phase III clinical trial, thereby improving the overall survival of patients who undergo HSCT. Vaccines and cell therapies for CMV must be further developed.
在接受造血干细胞移植(HSCT)的患者中,巨细胞病毒(CMV)感染直接或间接增加全因死亡率和非复发死亡率。尽管抢先治疗可抑制CMV感染,但与未发生CMV再激活的患者相比,它并不能改善发生CMV再激活患者的非复发死亡率。根据世界卫生组织国际标准(WHO IS),定量聚合酶链反应最近已被用作监测CMV的全球标准,而马立巴韦、布林西多福韦和来特莫韦已被开发为治疗CMV感染的新型抗病毒药物。来特莫韦是一类抗CMV药物,强烈抑制病毒DNA切割和包装所需的CMV DNA末端酶复合物。在一项III期临床试验中,它显著抑制了CMV感染,从而提高了接受HSCT患者的总体生存率。CMV疫苗和细胞疗法必须进一步开发。