Taming the Transplantation Troll by Targeting Terminase

The immunosuppressive drugs required after stem-cell transplantation render patients susceptible to opportunistic infections. The most important of these infections, in terms of both abundance and severity, is cytomegalovirus (CMV), which has been dubbed the “troll of transplantation.”1 Fortunately, the clinical effects of CMV infection have been reduced by preemptive therapy. Levels of CMV DNA in the blood (viremia) are monitored with the use of polymerase-chain-reaction (PCR) assays and, if viremia is detected, patients receive ganciclovir (or its prodrug valganciclovir) until viral DNA is no longer detectable.2 In addition to controlling overt CMV end-organ disease, since these agents are used only . . .