MINI REVIEW article
Front. Pediatr.
Sec. Pediatric Hematology and Hematological Malignancies
Volume 13 - 2025 | doi: 10.3389/fped.2025.1663600
This article is part of the Research TopicTreatment of Viral Infections Following Hematopoietic Stem Cell TransplantationView all articles
Revisiting Cytomegalovirus in Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients: Current Strategies for Prevention and Management in the Letermovir Era
Provisionally accepted
- 1Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, United States
- 2The University of Tennessee Health Science Center, Memphis, United States
- 3The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, United States
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CMV infection remains the most common clinically significant infection in pediatric allogeneic hematopoietic stem cell (HCT) recipients, with seropositive recipients of transplants from seronegative donors at the highest risk for complications. In recent years, letermovir, a novel antiviral with a favorable toxicity profile, was approved first for adults and more recently for pediatric patients for the primary prophylaxis of CMV infection and disease in high-risk HCT recipients. Growing evidence from real-life data regarding the safety and efficacy of letermovir has transformed the landscape of CMV disease in HCT transplant recipients and led to a paradigm shift from a preemptive approach to prophylaxis. Other novel additions to the diagnosis, risk stratification, and treatment of CMV include the measurement of CMV-specific cellular-mediated immunity and the approval of maribavir as a treatment option for resistant/refractory CMV infection and disease. Other prevention and treatment modalities currently under development include virus-specific T cells, monoclonal antibodies, and vaccines. Despite these promising advancements, additional pediatric-specific studies are needed to better understand the viral and immunological implications of these novel preventive and therapeutic methods in this patient population.
Keywords: CMV, antiviral, Hematopoietic cell transplant, pediatric, Letermovir
Received: 10 Jul 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Hiskey, Hijano and Zakhour. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Diego Raul Hijano, Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, United States
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