CMV after hematopoietic stem cell transplantation: Difference between revisions

From IDWiki
m (Text replacement - "Clinical Presentation" to "Clinical Manifestations")
Line 1: Line 1:
āˆ’
== 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%)
āˆ’
* Antiviral treatment:
  
  +
āˆ’
** [[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"
āˆ’
! Serostatus
 +
!Serostatus
āˆ’
! Blood products
 +
!Blood products
āˆ’
! Duration of PET
 +
!Duration of PET
 
|-
  
|-
āˆ’
| D-/R-
 +
|D-/R-
āˆ’
| CMV safe
 +
|CMV safe
āˆ’
| weeks 2 to 12
 +
|weeks 2 to 12
 
|-
  
|-
āˆ’
| D+/R-
 +
|D+/R-
āˆ’
| CMV safe
 +
|CMV safe
āˆ’
| weeks 2 to 12
 +
|weeks 2 to 12
 
|-
  
|-
āˆ’
| autologous R-
 +
|autologous R-
āˆ’
| CMV safe
 +
|CMV safe
āˆ’
| weeks 2 to 5
 +
|weeks 2 to 5
 
|-
  
|-
āˆ’
| DĀ±/R+
 +
|DĀ±/R+
āˆ’
| CMV untested
 +
|CMV untested
āˆ’
| weeks 2 to 12, then q2-4wk until week 26
 +
|weeks 2 to 12, then q2-4wk until week 26
 
|-
  
|-
āˆ’
| autologous R+
 +
|autologous R+
āˆ’
| CMV untested
 +
|CMV untested
āˆ’
| weeks 2 to 5
 +
|weeks 2 to 5
 
|}
  
|}
   
āˆ’
=== CMV disease ===
 +
===CMV Disease===
  +
āˆ’
* 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
āˆ’
* 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]]

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
  • 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
Retrieved from "https://idwiki.org/index.php?title=CMV_after_hematopoietic_stem_cell_transplantation&oldid=6678"
Powered by MediaWiki
Powered by Semantic MediaWiki