Cytomegalovirus (CMV) is a very common virus that remains latent after infection and can reactivate at any time. This investigation aimed to find out if CAR-T therapy can lead to CMV reactivation in patients with latent infection and haematological malignancies treated with new therapies such as CAR-T, which increase antitumor efficacy, but may have an impact on susceptibility to this. virus and in monitoring, prophylaxis or treatment strategies.

In this study, 51 CMV-seropositive patients (patients who had already had previous contact with CMV) undergoing CAR-T therapy at the Clinical Hospital of Valencia or Hospital La Fe were recruited. Plasma CMV DNAemia was monitored, that is, the presence of CMV in the patient’s blood. Next, using real-time polymerase chain reaction assays, the presence or absence of CMV in the patient’s blood (DNAemia) was determined.

The study concludes that CMV DNAemia was a common phenomenon in patients, but resolved spontaneously and did not lead to end-organ disease in any case. The researchers believe that patients with CAR-T may benefit from routine monitoring for CMV DNAemia, especially those who are CMV seropositive with CMV DNAemia detected at baseline.

Among others, David Navarro, Professor of Microbiology at the University of Valencia (UV) and head of the Microbiology Service of the Clinical Hospital, as well as coordinator of the INCLIVA Molecular Microbiology and Microbial Pathogenesis Research Group; the INCLIVA Hematopoietic Transplant Research Group, coordinated by Carlos Solano Vercet, professor of Medicine at the UV and head of the Haematology and Hemotherapy Service of the Clinical Hospital; and Juan Carlos Hernández Boluda, from the same group and associate professor at the UV.

CAR-T cell (chimeric antigen receptor T-cell) therapy is a form of immunotherapy that has been shown to be effective in the treatment of certain types of cancer, especially blood cancers. The CAR-T cell treatment process involves several steps. First, using a procedure similar to donating blood, T cells are collected and sent to a laboratory where they are genetically modified to express a chimeric antigen receptor (CAR) specific for the antigen present on cancer cells. Once the T cells have been modified, they are multiplied in the laboratory to obtain a sufficient number of CAR-T cells that are infused into the patient via intravenous transfusion to selectively kill cancer cells.

The presence of CMV in blood can be detected in a large percentage of seropositive patients treated with this therapy (up to 45%), but there is a lack of data about its behaviour and immunobiology, as well as its possible contribution to worsening clinical results.

Reference:

Solano de la Asunción C, Hernani R, Albert E, Gómez MD, Giménez E, Benzaquén A, González-Barberá EM, Hernández-Boluda JC, Pérez A, Piñana JL, Chorao P, Guerreiro M, Montoro J, Sanz J, Solano C, Navarro D. Cytomegalovirus DNAemia in haematological patients undergoing CD19-directed chimeric antigen receptor T-cell therapy: should it be systematically monitored? Clin Microbiol Infect. 2023 May 13:S1198-743X(23)00234-3. doi: 10.1016/j.cmi.2023.05.010. Epub ahead of print. PMID: 37182642.