A clinical trial led by researchers at Dana-Farber Cancer Institute and Brigham and Women's Hospital indicates that a new drug can often prevent a common, sometimes severe viral disease in patients receiving a transplant of donated blood-making stem cells. In a paper in the Sept. 26 issue of the New England Journal of Medicine, the researchers report that patients who took the drug CMX001 shortly after transplant were far less likely to develop cytomegalovirus (CMV) infection than were patients who took a placebo.
CMV disease is a common source of illness in transplant recipients and has long been a serious problem. If reactivated, "it can be associated with devastating complications including life-threatening injury to the lungs, gastrointestinal tract and other organs," said Dr. William Hogan, chair of hematology and oncology at the Mayo Clinic in Rochester, in an email to Reuters Health. Dr. Hogan was not involved in the research.
Assessment of immune reconstitution and immune competence post-hematopoietic cell transplantation
At Mayo Clinic, another tool in the possible prevention of CMV is the presence of a systematic process of evaluating immune recovery post-transplant. The process will identify individuals at higher risk for CMV primary infection or reactivation and Epstein-Barr virus (EBV)-associated B-cell posttransplantation lymphoproliferative disorder.
This immune monitoring process is also important to:
- Verify all components of the immune system (innate and adaptive) are effectively reconstituted (numerically and functionally) within an expected time interval. This determines successful immune competence and impacts long-term outcomes such as infection susceptibility and adequate tumor surveillance.
- Determine a personalized schedule for posttransplant vaccination based on an individual patient’s immune competence and reconstitution profile rather than a universal (one size fits all) and empirical protocol and ensure competent postvaccination response to vaccines.
- Identify markers associated with acute or chronic graft-versus-host disease (GVHD) and response to treatment for GVHD.
- Assess successful immune competence in correlation to maintenance of remission (for malignancies or autoimmunity) or correction of original defect for primary immunodeficiencies.
- Potentially identify markers associated with long-term graft failure or incomplete immune recovery.
The important role of immunology testing in hematology