Cytomegalovirus DNAemia in haematological patients undergoing CD19-directed chimeric antigen receptor T-cell therapy: should it be systematically monitored?

Cytomegalovirus (CMV) DNAemia may develop in a large percentage (up to 45%) of CMV-seropositive patients undergoing CD19-directed chimeric antigen receptor T-cell therapy [ [1] Chen G. Herr M. Nowak J. Ho C. Almyroudis N. Attwood K. et al. Cytomegalovirus reactivation after CD19 CAR T-cell therapy is clinically significant. Haematologica. 2023; 108: 615-620https://doi.org/10.3324/haematol.2022.281719 Crossref PubMed Scopus (2) Google Scholar , [2] Márquez-Algaba E. Iacoboni G. Pernas B. Esperalba J. Los Arcos I. Navarro V. et al. Impact of cytomegalovirus replication in patients with aggressive B cell lymphoma treated with chimeric antigen receptor T cell therapy. Transplant Cell Ther. 2022; 28: 851.e1-851.e8https://doi.org/10.1016/j.jtct.2022.09.007 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ] and may contribute to worsen clinical outcomes [ [1] Chen G. Herr M. Nowak J. Ho C. Almyroudis N. Attwood K. et al. Cytomegalovirus reactivation after CD19 CAR T-cell therapy is clinically significant. Haematologica. 2023; 108: 615-620https://doi.org/10.3324/haematol.2022.281719 Crossref PubMed Scopus (2) Google Scholar ]. Here by not administering preemptive antiviral therapy (PET) at low plasma CMV DNA loads (<1500 IU/mL, following local standard practice guidelines) we could gain a further insight on the kinetics of CMV DNAemia in these patients. In this retrospective, observational study, 51 consecutive CMV-seropositive patients (median age, 62 years; range, 22–79; 26 male) were included (Table S1). This study was approved by the respective research ethics committees, and informed consent was obtained from participants.