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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| + | * With monitoring and preemptive therapy, CMV pneumonitis has decreased to 5% of seropositive allogeneic recipients |
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| + | * [[Pneumonitis]] (63%) |
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| + | * [[Enteritis]] (26%) |
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| + | * [[Retinitis]] (5%) |
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== Management == |
== Management == |
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| + | === Preemptive therapy === |
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* 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 |
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* Antiviral treatment: |
* Antiviral treatment: |
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| weeks 2 to 5 |
| weeks 2 to 5 |
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| + | === CMV disease === |
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| + | * 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 |
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[[Category:Immunocompromised hosts]] |
[[Category:Immunocompromised hosts]] |
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Revision as of 21:27, 6 March 2020
Clinical Presentation
- 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 |
| D±/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
