CMV after hematopoietic stem cell transplantation - Revision history

Aidan at 21:21, 19 September 2020

2020-09-19T21:21:07Z

@@ Line 1: / Line 1: @@
 ==Clinical Manifestations==
@@ Line 5: / Line 38: @@
 *[[Enteritis]] (26%)
 *[[Retinitis]] (5%)
 ==Management==
 ===Preemptive Therapy===

Aidan: /* Management */

2020-09-12T01:06:51Z

Management

← Older revision		Revision as of 01:06, 12 September 2020
Line 1:		Line 1:
	== Clinical Manifestations ==		==Clinical Manifestations==
⚫	* With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients
⚫	* [[Pneumonitis]] (63%)
⚫	* [[Enteritis]] (26%)
⚫	* [[Retinitis]] (5%)

		⚫	*With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients
⚫	== Management ==
		⚫	*[[Pneumonitis]] (63%)
⚫	=== Preemptive ~~therapy~~ ===
		⚫	*[[Enteritis]] (26%)
⚫	* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
		⚫	*[[Retinitis]] (5%)
	* 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
		⚫	==Management==
⚫	** If concerns about oral ~~antiviral~~, ~~would~~ continue [[Is treated by::ganciclovir]] 5 mg/kg IV ~~daily (maintenance)~~
		⚫	===Preemptive Therapy===
⚫	** If ~~ganciclovir~~ resistance or bone marrow suppression, ~~next step is~~ [[Is treated by::foscarnet]] 90 mg/kg IV q12h ~~(induction) followed by q24h (maintenance)~~

⚫	* Use CMV safe (leukoreduced or filtered) blood products if the recipient is CMV seronegative
		⚫	*Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
			*Antiviral treatment follows a model of induction therapy for 14 days; if it has declined by at least 1 log, then step down to lower-dose maintenance therapy until viremia resolves fully; otherwise, continue induction dosing
			**Induction therapy
			***[[Is treated by::Ganciclovir]] 5 mg/kg q12h
		⚫	***If concerns about resistance or bone marrow suppression, [[Is treated by::foscarnet]] 90 mg/kg IV q12h
			**Maintenance therapy
			***[[Is treated by::Valganciclovir]] 900 mg po daily
		⚫	***If concerns about oral absorption, continue [[Is treated by::ganciclovir]] 5 mg/kg IV q24h
			***If concerns about resistance or bone marrow suppression, [[Is treated by::foscarnet]] 90 mg/kg IV q24h
		⚫	*Use CMV safe (leukoreduced or filtered) blood products if the recipient is CMV seronegative

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

	=== CMV ~~disease~~ ===		===CMV Disease===

	* Treatment is with [[Is treated by::ganciclovir]] induction for 14 to 21 days with IVIG 500 mg/kg every other day, followed by maintenance [[ganciclovir]] for at least 3 to 4 weeks		*Treatment is with [[Is treated by::ganciclovir]] induction for 14 to 21 days with IVIG 500 mg/kg every other day, followed by maintenance [[ganciclovir]] for at least 3 to 4 weeks
	* May need to continue maintenance for longer if patient has [[GVHD]], enteritis with deep ulcerations, or retinitis		*May need to continue maintenance for longer if patient has [[GVHD]], enteritis with deep ulcerations, or retinitis

	[[Category:Immunocompromised hosts]]		[[Category:Immunocompromised hosts]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-19T12:36:45Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:36, 19 July 2020
Line 1:		Line 1:
	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients		* With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients
	* [[Pneumonitis]] (63%)		* [[Pneumonitis]] (63%)

Aidan: added treatment of CMV disease

2020-03-07T01:27:28Z

added treatment of CMV disease

← Older revision		Revision as of 01:27, 7 March 2020
Line 1:		Line 1:
			== Clinical Presentation ==
			* With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients
			* [[Pneumonitis]] (63%)
			* [[Enteritis]] (26%)
			* [[Retinitis]] (5%)

	== Management ==		== Management ==
			=== Preemptive therapy ===
	* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold		* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
	* Antiviral treatment:		* Antiviral treatment:
Line 32:		Line 39:
	\| weeks 2 to 5		\| weeks 2 to 5
	\|}		\|}

			=== CMV disease ===
			* Treatment is with [[Is treated by::ganciclovir]] induction for 14 to 21 days with IVIG 500 mg/kg every other day, followed by maintenance [[ganciclovir]] for at least 3 to 4 weeks
			* May need to continue maintenance for longer if patient has [[GVHD]], enteritis with deep ulcerations, or retinitis

	[[Category:Immunocompromised hosts]]		[[Category:Immunocompromised hosts]]

Aidan at 01:21, 7 March 2020

2020-03-07T01:21:43Z

← Older revision		Revision as of 01:21, 7 March 2020
Line 4:		Line 4:
	** [[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		** [[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 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)		** If ganciclovir resistance or bone marrow suppression, 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		* Use CMV safe (leukoreduced or filtered) blood products if the recipient is CMV seronegative

Aidan: fixed treatment

2020-03-07T01:21:19Z

fixed treatment

← Older revision		Revision as of 01:21, 7 March 2020
Line 1:		Line 1:
	== Management ==		== Management ==
	* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold		* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
			* Antiviral treatment:
	* Treatment is typically with [[Is treated by::valganciclovir]] 900 mg po daily, but may need [[Is treated by::ganciclovir]] 5 mg/kg IV if no oral access, or [[Is treated by::foscarnet]] 90 mg/kg IV q12h followed by q24h if resistance is suspected
			** [[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		* Use CMV safe (leukoreduced or filtered) blood products if the recipient is CMV seronegative

Aidan: Created page with "== Management == * Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold * Treatment is typically with Is treated by::va..."

2020-03-07T01:05:55Z

Created page with "== Management == * Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold * Treatment is typically with Is treated by::va..."

New page

== Management ==
* Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
* Treatment is typically with [[Is treated by::valganciclovir]] 900 mg po daily, but may need [[Is treated by::ganciclovir]] 5 mg/kg IV if no oral access, or [[Is treated by::foscarnet]] 90 mg/kg IV q12h followed by q24h if resistance is suspected
* 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]]