Hematopoietic Stem Cell Transplant: Infection Control - Episode 12

Addressing Unmet Needs in CMV Infection


Roy Chemaly, MD: Having letermovir available for prophylaxis is going to change the paradigm of addressing cytomegalovirus infection in transplant recipients. In the future, I think we’re probably going to see a shift from preemptive therapy to a prophylactic regimen, or strategy, with a new, safe and effective drug for prophylaxis in this high-risk patient population—meaning recipient-positive for CMV after allotransplant.

There are a few ongoing clinical trials. Maribavir has been tested for CMV resistance in allogeneic stem cell transplant. So, it is a treatment option for a setting where other anti-CMV drugs have failed. There is also another trial, a phase 3 trial, for maribavir as preemptive therapy. Hopefully, in the future, if it turns out to be effective—we know from the phase 2 trial that it worked in this patient population for CMV resistance—it will be another drug that will be really helpful in treating someone with breakthrough infection, or resistant infection, or refractory infection. It will help us to control this kind of infection. Right now, we use the drugs that we have available, which are pretty toxic. Sometimes, we use them in combination. As you could imagine, there could be a much higher incidence of side effects than if you use them as monotherapy.

For CMV, there are other strategies under development. You have T-cell therapy, CMV-specific T cell. This is being tested in patients who have refractory CMV infection. But, it’s also being tested for the prevention of CMV reactivation. So, stay tuned. We may see some results in the near future.

CMV vaccine—another strategy being developed. Unfortunately, one of the recent CMV vaccine trials that was completed for stem cell transplant recipients was a negative trial. The trial did not reach the primary or secondary endpoints. So, at least one of the CMV vaccines is not going to be further developed. But, there’s another trial ongoing for another type of CMV vaccine. So, stay tuned. Hopefully, we’ll hear some good news in the near future. As you can see, there are different strategies under development. We still need new drugs or strategies to address resistant CMV, the treatment of CMV infection, and even prophylaxis, as well, in addition to letermovir.

Transcript Edited for Clarity