View source for CMV after hematopoietic stem cell transplantation

== Management ==
* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
* Antiviral treatment:
** [[Is treated by::ganciclovir]] 5 mg/kg q12h for 7 to 14 days (induction) followed by [[Is treated by::valganciclovir]] 900 mg po daily (maintenance) until a few weeks after viremia resolves
** If concerns about oral antiviral, would continue [[Is treated by::ganciclovir]] 5 mg/kg IV daily (maintenance)
** If ganciclovir resistance, next step is [[Is treated by::foscarnet]] 90 mg/kg IV q12h (induction) followed by q24h (maintenance)
** Major adverse effect of ganciclovir is bone marrow suppression
* Use CMV safe (leukoreduced or filtered) blood products if the recipient is CMV seronegative

{| class="wikitable sortable"
! Serostatus
! Blood products
! Duration of PET
|-
| D-/R-
| CMV safe
| weeks 2 to 12
|-
| D+/R-
| CMV safe
| weeks 2 to 12
|-
| autologous R-
| CMV safe
| weeks 2 to 5
|-
| D±/R+
| CMV untested
| weeks 2 to 12, then q2-4wk until week 26
|-
| autologous R+
| CMV untested
| weeks 2 to 5
|}

[[Category:Immunocompromised hosts]]