Bandeira Tayná F G S, Marti Luciana C, Rother Edna T, Correia Lucas Reis, Machado Clarisse M
PROADI-SUS, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, SP, Brazil.
Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, SP, Brazil.
Pharmaceutics. 2024 Oct 11;16(10):1321. doi: 10.3390/pharmaceutics16101321.
Cytomegalovirus (CMV) poses a significant threat to post-hematopoietic cell transplantation (HCT). Control strategies include letermovir prophylaxis or ganciclovir pre-emptive therapy (PET). Without prophylaxis, 65-90% of seropositive recipients develop a clinically significant CMV infection. Due to PET drawbacks, letermovir prophylaxis is preferable, as it reduces CMV-related events and improves overall survival. However, refractory or resistant CMV-CS remains a challenge, with maribavir showing limited efficacy. This systematic review followed the Cochrane Manual and PRISMA guidelines and was registered in PROSPERO. Searches were conducted in PubMed, Scopus, Embase, and Web of Science. Out of 1895 identified records, 614 duplicates were removed, and subsequent screening excluded 1153 studies. Eleven included studies (2012-2024) involved 255 HCT recipients receiving adoptive immunotherapy (AI), primarily CMV-specific T-cell therapy. GvHD occurred in 1.82% of cases. Adverse events occurred in 4.4% of cases, while mild CRS was observed in 1.3% of patients. Efficacy, evaluated in 299 patients across eleven studies, showed an average response rate of 78.2%. CMV-CS recurrence was observed in 24.4% of 213 patients, and death due to CMV was reported in 9.7% of 307 patients across nine studies. Adoptive hCMV-specific T-cell immunotherapy appears to be a safe, effective alternative for refractory CMV-CS in HCT.
巨细胞病毒（CMV）对造血细胞移植（HCT）后患者构成重大威胁。控制策略包括来特莫韦预防或更昔洛韦抢先治疗（PET）。在未进行预防的情况下，65 - 90%的血清反应阳性受者会发生具有临床意义的CMV感染。由于PET存在缺点，来特莫韦预防更为可取，因为它可减少CMV相关事件并提高总体生存率。然而，难治性或耐药性CMV-CS仍然是一个挑战，马瑞巴韦的疗效有限。本系统评价遵循Cochrane手册和PRISMA指南，并在PROSPERO中注册。检索了PubMed、Scopus、Embase和科学网。在1895条已识别记录中，去除了614条重复记录，随后的筛选排除了1153项研究。纳入的11项研究（2012 - 2024年）涉及255例接受过继性免疫治疗（AI）的HCT受者，主要是CMV特异性T细胞治疗。移植物抗宿主病（GvHD）发生率为1.82%。不良事件发生率为4.4%，而1.3%的患者观察到轻度细胞因子释放综合征（CRS）。在11项研究中的299例患者中评估的疗效显示，平均缓解率为78.2%。在213例患者中有24.4%观察到CMV-CS复发，在9项研究中的307例患者中有9.7%报告了因CMV导致的死亡。过继性hCMV特异性T细胞免疫治疗似乎是HCT中难治性CMV-CS的一种安全、有效的替代方法。
