Drug development for the treatment and prevention of viral infection in children after transplant has seen significant advancement in recent years, but not all of it has been good news. A new drug recently received pediatric approval for a specific infection; meanwhile, studies examining virus-specific T-cells ended early because of poor outcomes.

The Feb. 12 Pediatric Track session Concurrent: Cells Or Drugs: The Future of Antiviral Therapy in Transplant will provide a summary of these and other developments in the field starting at 10:30 a.m. in Room 313 ABC. It will be available for on-demand viewing for registered attendees of the 2025 Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT® and CIBMTR® following the live presentation.

“As transplanters, we continue to struggle with viral illnesses after transplant,” said Session Chair Caitlin Elgarten, MD, MSCE, an attending physician for the Cancer Center at Children’s Hospital of Philadelphia. “It’s eluded the field as one of the potential morbidities and mortalities that we talk to patients about that we haven’t figured out how to eliminate, so the goal of this session is to give a balanced update on where the field stands with regard to both preventing viral infections as well as treating them.”

Elgarten will present a practical approach to integrating antiviral modalities that include alternative methods of preventing viral infection, vaccines, and graft manipulation. She will be joined by presenters Michael Keller, MD, and Michael Boeckh, MD, PhD.

A T-cell biologist who has been at the forefront of the development of cytotoxic T lymphocytes (CTLs), Keller will provide updates on the role and efficacy of virus-specific T-cells. He is the director of the Translational Research Laboratory in the Cell Enhancement and Technologies for Immunotherapy Program and of the Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiency Disorders at Children’s National Hospital.

“There have been recent attempts to rigorously study the virus-specific T-cells, which we have been using for a long time but had not had comparative studies on,” Elgarten said. “Recent attempts at comparative studies actually closed for futility, and that has left many in the field trying to better understand those agents and where they can be helpful. Many of us still think there’s a role for them, but they’re not going to work for everybody. This is a nice time to regroup about both strategies — where they can help, where we have good data, what the limitations of both are, and what’s next.”

Among the promising developments in the field, in 2024, letermovir received U.S. Food and Drug Administration (FDA) approval for the prophylaxis of cytomegalovirus (CMV) infection and disease in children 6 months and older.

Boeckh, professor and head of the Infectious Disease Sciences Program in the Vaccine and Infectious Disease Division at the Fred Hutchinson Cancer Center, will explain the current landscape of antiviral drugs, including letermovir, and what the future looks like for the use of these agents in the pediatric transplant population. He will discuss new medications, the proven benefits of their use, as well as their limits.

“He has led most of the innovation in antivirals in the space, on the adult side or the pediatric side, as far as thinking about antiviral mechanism of action and what agent works for what, as well as which patients can benefit from antivirals in which circumstances,” Elgarten said.

While this session is part of the Pediatric Track agenda, Elgarten said anyone with an interest in the clinical aspect of transplant would find it valuable.

“This is for anyone who wants to update their understanding of what’s new in the field and the changing practices for how we treat or prevent viral infections after transplant,” she said. “Anyone who wants that background could benefit from this session.”