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

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

Kristen G. Valencia Deray,1, Lara A. Danziger-Isakov,2,3 and Kevin J. Downes4,5,
1Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA, 2Division of Infectious Disease, Cincinnati Children’s Hospital
Medical Center, Cincinnati, Ohio, USA, 3Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA, 4Division of Infectious Diseases, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania, USA, 5Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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.
Key words. antiviral; cytomegalovirus; pediatric; resistance; transplantation.