Current and Emerging Antiviral Agents in the Prevention and Treatment of Cytomegalovirus in Pediatric Transplant Recipients

Authors

Kristen G Valencia Deray
Lara A Danziger-Isakov
Kevin J Downes

Publication Date

2-28-2024

Journal

Journal of the Pediatric Infectious Diseases Society

DOI

10.1093/jpids/piad059

PMID

38417084

PMCID

PMC10901473

PubMedCentral® Posted Date

2-28-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Adult, Humans, Child, Cytomegalovirus, Antiviral Agents, Transplant Recipients, Cytomegalovirus Infections, Hematopoietic Stem Cell Transplantation, Acetates, Quinazolines, antiviral, cytomegalovirus, pediatric, resistance, transplantation

Abstract

Despite current prophylaxis regimens, cytomegalovirus (CMV) is common in hematopoietic cell transplantation (HCT) and solid organ transplantation (SOT) and remains a significant cause of morbidity and mortality. Newer antiviral medications are reshaping the landscape for prevention and treatment of CMV DNAemia, infection, and disease. Letermovir is approved for CMV prevention in adult HCT patients and is attractive due to the absence of marrow suppression seen with ganciclovir/valganciclovir. Letermovir should not be routinely used for CMV treatment due to its low threshold for resistance. Maribavir is approved for the treatment of refractory or resistant CMV disease in HCT and SOT recipients ≥12 years of age, though it has no current role in CMV prevention. More research is needed to fully elucidate the roles, efficacy, and safety of these newer agents in prevention and treatment of CMV in pediatric transplant recipients.