CMV after hematopoietic stem cell transplantation: Difference between revisions

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(added treatment of CMV disease)
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== Clinical Presentation ==
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== 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%)

Revision as of 08:36, 19 July 2020

Clinical Manifestations

  • With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients
  • Pneumonitis (63%)
  • Enteritis (26%)
  • Retinitis (5%)

Management

Preemptive therapy

  • Most frequently managed with weekly viral loads and preemptive treatment (PET) at a lab-specific threshold
  • Antiviral treatment:
    • ganciclovir 5 mg/kg q12h for 7 to 14 days (induction) followed by valganciclovir 900 mg po daily (maintenance) until a few weeks after viremia resolves
    • If concerns about oral antiviral, would continue ganciclovir 5 mg/kg IV daily (maintenance)
    • If ganciclovir resistance or bone marrow suppression, next step is 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
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
DĀ±/R+ CMV untested weeks 2 to 12, then q2-4wk until week 26
autologous R+ CMV untested weeks 2 to 5

CMV disease

  • Treatment is with 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