CMV after hematopoietic stem cell transplantation: Difference between revisions
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+ | ==Clinical Manifestations== |
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ā | * Antiviral treatment: |
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ā | ** [[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 |
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+ | *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 |
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+ | **Induction therapy |
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+ | ***[[Is treated by::Ganciclovir]] 5 mg/kg q12h |
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+ | **Maintenance therapy |
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+ | ***[[Is treated by::Valganciclovir]] 900 mg po daily |
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+ | ***If concerns about resistance or bone marrow suppression, [[Is treated by::foscarnet]] 90 mg/kg IV q24h |
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ā | ! |
+ | !Serostatus |
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+ | !Blood products |
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+ | !Duration of PET |
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+ | |D-/R- |
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+ | |CMV safe |
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+ | |weeks 2 to 12 |
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+ | |D+/R- |
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+ | |CMV safe |
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+ | |weeks 2 to 12 |
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+ | |autologous R- |
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+ | |CMV safe |
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+ | |weeks 2 to 5 |
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+ | |DĀ±/R+ |
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+ | |CMV untested |
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+ | |weeks 2 to 12, then q2-4wk until week 26 |
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+ | |autologous R+ |
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+ | |CMV untested |
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+ | |weeks 2 to 5 |
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ā | === |
+ | ===CMV Disease=== |
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ā | * |
+ | *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 |
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+ | *May need to continue maintenance for longer if patient has [[GVHD]], enteritis with deep ulcerations, or retinitis |
[[Category:Immunocompromised hosts]] |
[[Category:Immunocompromised hosts]] |
Revision as of 21:06, 11 September 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 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
- Ganciclovir 5 mg/kg q12h
- If concerns about resistance or bone marrow suppression, foscarnet 90 mg/kg IV q12h
- Maintenance therapy
- Valganciclovir 900 mg po daily
- If concerns about oral absorption, continue ganciclovir 5 mg/kg IV q24h
- If concerns about resistance or bone marrow suppression, foscarnet 90 mg/kg IV q24h
- Induction therapy
- Use CMV safe (leukoreduced or filtered) blood products if the recipient is CMV seronegative
Serostatus | Blood products | Duration of PET |
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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