Combination oral letermovir, VGC/GCV, and CMV-HIG achieved stable CMV viremia clearance (Di Cristanziano et al., 2021). treatment-related mortality or serious adverse events were associated. Conclusion: CMV-HIG is an effective treatment option in SCT patients that is as safe as antivirals alone. Preemptive BMN673 CMV-HIG with antivirals may provide the added advantage of reduced time to viremia clearance without adding renal injury. Larger, prospective studies are needed to evaluate CMV-HIG’s impact on time to viremia clearance and the effectiveness of preemptive CMV-HIG use with antivirals. Cytomegalovirus (CMV) is a major cause of morbidity and mortality in immunocompromised patients following stem cell transplant (SCT; Styczynski, 2017). Cytomegalovirus remains latent after primary infection and can reactivate in a host during a time of immune suppression. Due to immune suppression, SCT patients are among those at risk for CMV reactivation, causing CMV viremia. It has been estimated that BMN673 the median rate of CMV recurrence in SCT patients is 37% (Styczynski, 2017). Identifying successful management of CMV viremia is important for minimizing mortality in this population. BACKGROUND In recent years, BMN673 there have been advancements in the use of antiviral medications for prophylactic and preemptive treatment of CMV viremia in SCT patients. Prophylaxis describes the administration of antiviral drugs to patients at risk of developing CMV disease following transplantation for a specified period of time in order to prevent infection (Gilioli et al., 2021; Goldstein et al., 2017; Meesing & Razonable, 2018). Preemptive therapy differs from prophylaxis as it describes a strategy in which antiviral drugs are given to patients with evidence of active CMV replication with viral loads above a threshold (Gilioli et al., 2021). High CMV viral load has been identified as a risk factor for death in SCT patients (Green et al., 2016). Cytomegalovirus DNA conversion, described as the time to negative CMV polymerase chain reaction (PCR) in blood or plasma, is typically confirmed with two consecutive tests and is used as a measure of successful CMV viremia treatment (Alsuliman et al., 2018; Camargo et al., 2018; Meesing & Razonable, 2018). Intravenous CMV hyperimmunoglobulin (HIG) contains high concentrations of specific immunoglobulins targeted against CMV. Cytomegalovirus HIG is purified from donors recently vaccinated or recovering from CMV (Arumugham & Rayi, 2022. The goal of administration of CMV-HIG is to neutralize specific CMV antigens, thereby providing passive immunity to CMV to recipients (Arumugham & Rayi, 2022). The utilization of CMV-HIG as a concomitant therapy has been described in the solid organ transplant setting (Meesing & Razonable, 2018; Schulz et al., 2016). Prior to 2011, there were two systematic reviews and meta-analyses focused on immunoglobulin prophylaxis in SCT (Raanani et al., 2008; Raanani et al., 2009). In 2018, a systematic review and meta-analysis was published focusing on the effectiveness of immunoglobulin prophylaxis in SCT patients (Ahn et al., 2018). There has not been a literature review focused on preemptive use of intravenous CMV-HIG. The purpose of this review is to consolidate findings in the recent literature regarding the preemptive use of CMV-HIG during treatment of CMV viremia in SCT patients and to identify situations when preemptive CMV-HIG could be beneficial. METHODS A review of the literature was performed with the assistance of a research librarian utilizing PubMed and Scopus electronic databases. Search terms used were cytomegalovirus, CMV, immunoglobulins, immunoglobulin, IVIG, CMV-IG, hematopoietic stem cell transplantation, and stem cell. In order to capture recent publications, the search was limited to publications from 2011 to 2021. Included studies were limited to those in English with human participants who had undergone an SCT and developed subsequent CMV viremia. All ages were included. Included studies discussed SCT, immunoglobulins, and cytomegalovirus. Rabbit polyclonal to ATF1.ATF-1 a transcription factor that is a member of the leucine zipper family.Forms a homodimer or heterodimer with c-Jun and stimulates CRE-dependent transcription. Studies were excluded if they were a duplicate, were focused on prophylaxis, did not discuss intravenous immunoglobulins, or were abstracts only. After a review of the abstract and/or the full text of the article, articles that focused on single end-organ involvement, cost, non-hyperimmune globulin products, or animal-derived immune globulin products were excluded. A total of five articles met the inclusion and exclusion criteria and are incorporated in this review (Figure 1). Open in BMN673 a separate window Figure 1 Screening process for literature review. NK = natural killer; EBV = Epstein-Barr virus. RESULTS The five articles included three retrospective analyses and two case studies (Tables 1 and ?and2).2). Each of the five studies describe the effectiveness of combination antiviral therapy with CMV-HIG (Alsuliman et al., 2018; Di BMN673 Cristanziano et al., 2021; Frietsch et.
Combination oral letermovir, VGC/GCV, and CMV-HIG achieved stable CMV viremia clearance (Di Cristanziano et al
