CMV after hematopoietic stem cell transplantation: Difference between revisions

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(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...")
 
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== 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
 
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** [[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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** If concerns about oral antiviral, would continue [[Is treated by::ganciclovir]] 5 mg/kg IV daily (maintenance)
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** If ganciclovir resistance, next step is [[Is treated by::foscarnet]] 90 mg/kg IV q12h (induction) followed by q24h (maintenance)
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** 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
   

Revision as of 21:21, 6 March 2020

Management

  • 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, next step is 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
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