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Efficacy of artesunate for treatment of cytomegalovirus reactivation post allogeneic haematopoietic stem cell transplants

Bone Marrow Transplantation volume 58, pages 209–211 (2023)Cite this article

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Post-transplant CMV reactivation rates in India are high [1, 2]. Ganciclovir is the drug of choice for pre-emptive therapy however, myelosuppression which is a prominent side effect precludes its use in many post-transplant patients. Second-line agents (foscarnet and cidofovir) are expensive and not easily available in India. Artesunate is an inexpensive antimalarial agent and has been sporadically reported in literature to be effective in ganciclovir-resistant CMV infections [3, 4]. However, these reports are limited to a very small number of patients. Artesunate has been shown to inhibit CMV replication in vitro and in vivo [5] and acts against ganciclovir-resistant strains as well [6]. Artesunate acts by decreasing levels as well as DNA binding of transcription factors and subsequently inhibits cellular activation pathways [6]. Another postulated mechanism is arrest of cell cycle progression [7]. Here we report the utility of artesunate in post allogeneic transplant (allo-HCT) patients who could not be given ganciclovir due to toxicities or had ganciclovir failure.

This retrospective single-centre study conducted in a tertiary cancer centre in India included all allo-HCT recipients between April 2015 and October 2018. One hundred and seventeen patients underwent allo-HCT in this period. Of these, 72 underwent matched sibling donor transplants (MSD), 35 underwent haploidentical transplants (HIT), 7 underwent matched-unrelated donor transplants (MUD) and 3 had mismatched sibling donor (MMSD) transplants (Table 1).

Table 1 CMV-related demographics in the complete cohort of 117 patients.
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Fig. 1: Treatment of CMV reactivations–1st line, 2nd line, and 3rd line therapy for CMV.

Data availability

The data that supports findings of this study is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Medical Oncology, Tata Memorial Centre, Mumbai, India

    Anant Gokarn, Ramnath Shenoy, Sachin Punatar, Sumeet Mirgh, Akanksha Chichra, Lingaraj Nayak, Avinash Bonda, Nishant Jindal, Megha Saroha, Anup Toshniwal & Navin Khattry

  2. Homi Bhabha National Institute, Mumbai, India

    Anant Gokarn, Sachin Punatar, Sumeet Mirgh, Akanksha Chichra, Lingaraj Nayak, Avinash Bonda, Nishant Jindal, Vivek Bhat, Sanjay Biswas & Navin Khattry

  3. Consultant, Infectious diseases; Deenanath Mangeshkar Hospital and Research Centre, Pune, India

    Parikshit Prayag

  4. Huwel Lifesciences Pvt. Ltd., Hyderabad, India

    Rachana Tripathi & Shesheer Kumar

  5. Department of Microbiology, Tata Memorial Centre, Mumbai, India

    Vivek Bhat & Sanjay Biswas

Authors
  1. Anant Gokarn
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Contributions

AG was responsible for data extraction, writing the first draft of the manuscript, and editing the manuscript. RS and AT were responsible for data extraction, analysis, and creating figures and tables. SP, SM, AC, LR, AB, NJ, MS, and PP were responsible for correcting and improving the manuscript draft and also contributed to patient care. RT, SK, VB, and SB were responsible for conducting CMV QPCR tests on blood and tissue samples. NK was responsible for conceptualisation of the study and final draft editing.

Corresponding author

Correspondence to Navin Khattry.

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Gokarn, A., Shenoy, R., Punatar, S. et al. Efficacy of artesunate for treatment of cytomegalovirus reactivation post allogeneic haematopoietic stem cell transplants. Bone Marrow Transplant 58, 209–211 (2023). https://doi.org/10.1038/s41409-022-01850-z

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