Therapeutic strategies for the prevention and treatment of cytomegalovirus infection

INTRODUCTION: CMV remains a significant cause of morbidity and mortality in immunosuppressed patients, particularly following allogeneic haematopoietic transplantation. This reflects the inability of depressed host immunity to contain viral replication, principally through the loss of T-cell function. There is a clear rationale for the restoration of CMV-specific immunity using adoptive T-cell immunotherapy. AREAS COVERED: This review analyses current treatment strategies for prophylaxis and preemptive treatment of CMV with a particular focus on patients following allogeneic haematopoietic transplantation. The main emphasis of this review is the role of adoptive T-cell therapy, particularly some of the newer direct selection technologies that allow the rapid generation of a GMP-compliant cellular product. Relevant studies were selected from PubMed. Search terms: allogeneic transplant, cytomegalovirus, multidrug-resistant virus, adoptive T-cell therapy. EXPERT OPINION: A number of early studies showed that T-cell therapies can be delivered safely and are efficacious. However, they relied on culture techniques that make wider application difficult. Newer direct selection techniques have allowed production of cellular products more rapidly, cheaply, and to GMP standards. Clinical trials will help define the role of these cellular products, which have the potential to alter our entire approach to the treatment of CMV infection.