Journal: Bone marrow transplantation
This review provides updated insights on the prevention and management of cytomegalovirus (CMV) infections in pediatric hematopoietic stem cell transplant recipients.
It highlights that CMV-seropositivity rates are lower in pediatric patients compared to adults, with the highest infection risk in recipients who are seropositive and donors seronegative.
Key pediatric risk factors mirror those in adults, including:
- Recipient seropositivity
- Alternative donor transplants
- Older age
- Graft-versus-host disease
Donor CMV-seronegativity in seropositive recipients is associated with worse survival and increased non-relapse mortality.
While preemptive treatment has traditionally been the main management strategy, the recent FDA and EMA approval of letermovir for children marks a significant advancement, shifting prophylaxis practices in pediatrics.
For clinically significant or refractory CMV infections, agents such as maribavir and viral-specific T-cell therapies offer effective, less toxic alternatives to conventional antivirals.