What do our experts say?
Can a common virus help inform treatment planning for stem cell transplant patients? WideCells Group CSO Peter Hollands reviews the research.
Graft versus host disease (GvHD) is an issue for almost all stem cell transplantees to a greater or lesser extent, but a new study demonstrates that a common virus could hold a partial solution.
The human cytomegalovirus (CMV) is a form of the herpes virus that many of us carry. It usually lies dormant, only usually becoming symptomatic during immunosuppression – such as that experienced by stem cell transplantees who have undergone high dose chemo, and have severely limited immune systems as a result.
When that immunosuppression allows CMV to rear its head, it’s also an opportunity for the CMV to potentiate GvHD, making symptoms more acute. That means that patients carrying CMV are much more at risk of severe GvHD than other stem cell tranplantees - but it also implies that through testing for CMV ahead of time, the risk of GvHD could be reduced.
To understand why this is possible, it’s important to know how decisions regarding GvHD treatment are usually made. Following an allogeneic (donor-based) stem cell transplant, doctors will then evaluate whether the patient is suffering from GvHD, if they are, how severely. If it’s judged to be sufficiently severe, antiviral drugs will be prescribed. This study instead proposes that instead of waiting till the post-transplant stage to make a decision regarding antiviral drugs, they are prescribed pre-transplant to all patients who test positive for CMV.
This would mean that the medication is included as standard as part of the other drugs prescribed as part of the transplant protocol.
The overhead in terms of time and cost is relatively low, since CMV is already tested for as a matter of course in all pre-transplant patients – and an antiviral drug is a minimal addition to the already generous number of medications that a transplantee will be receiving as standard.
An interesting study - the risks of the approach it recommends appear minimal and the potential benefits seem high.