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March 09, 2023
Maribavir: A New Treatment For Resistant Cytomegalovirus Infections: Maribavir is indicated for the treatment of adult and pediatric patients with post-transplant cytomegalovirus (CMV) infection or disease refractory to treatment with ganciclovir, valganciclovir, cidofovir, or foscarnet. Maribavir demonstrated efficacy against resistant CMV and was associated with fewer severe adverse effects compared to other treatments. This medication has the potential for several drug interactions which can be managed via dose modification or close monitoring. Overall, it’s well tolerated and has a unique role within the treatment of CMV when there is resistance or patients cannot tolerate alternative agents.
Upon completion of the chapter, the reader will be able to:
Explain the rationale for using hematopoietic stem-cell transplant (HCT) to treat cancer, immune disorders, or hemoglobinopathies.
Compare the different types of HCTs, specifically (a) the types of donors (ie, autologous and allogeneic), (b) the source of hematopoietic cells (ie, peripheral blood progenitor cells, bone marrow, and umbilical cord blood), and (c) the type of preparative regimen (ie, myeloablative and nonmyeloablative).
Develop a plan for monitoring and managing engraftment of hematopoiesis and potential complications of engraftment.
List the nonhematologic toxicity to high-dose chemotherapy used in myeloablative preparative regimens, specifically busulfan-induced seizures, hemorrhagic cystitis, gastrointestinal toxicities, and sinusoidal obstruction syndrome.
Explain graft-versus-host disease (GVHD) including pathophysiology, differences between acute and chronic, and grading of acute GVHD.
Recommend a prophylactic and treatment regimen for GVHD.
Choose a regimen to minimize the risk of infectious complications in HCT patients.
Evaluate the long-term health care of HCT survivors.
Hematopoietic stem-cell transplant (HCT), which is often referred to as bone marrow transplant (BMT), involves the administration of CD34+ hematopoietic stem cells (HSCs) into a recipient with damaged, dysfunctional, or depleted HSCs and immune cells after administration of a preparative (or conditioning) regimen of chemotherapy, radiotherapy, or both.1 While this process is a life-saving procedure most often used in malignant conditions, it may be used to replace dysfunctional immune deficiency syndromes like severe combined immunodeficiency syndrome (SCID), hemoglobinopathies such as sickle cell anemia, and other disorders such as scleroderma, an autoimmune disorder.2 There are two main types of HCTs, autologous HCT where the recipient receives their own HSCs and an allogeneic HCT where the recipient receives HSCs from either a related or unrelated donor (URD). Hematopoietic stem cells may be obtained from bone marrow (BM), peripheral blood progenitor cells (PBPCs), or umbilical cord blood (UCB). BM and PBPCs contain pluripotent stem cells and postthymic lymphocytes, which are responsible for long-term hematopoietic reconstitution (engraftment) and immune recovery.1
The rationale of an autologous HCT for a malignant condition is to administer high doses of chemotherapy to maximize therapeutic activity against the cancer and then “rescue” the BM with the ...