How I treat CMV reactivation after allogeneic hematopoietic stem cell transplantation

• Published in: Blood Vol. 135; no. 19; pp. 1619 - 1629
• Main Authors: Einsele, Hermann, Ljungman, Per, Boeckh, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 07.05.2020; American Society of Hematology
• Subjects: Adult; Antiviral Agents - therapeutic use; Cytomegalovirus - drug effects; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - pathology; Female; Hematologic Diseases - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; How I Treat; Humans; Major Complications after Allogeneic Stem Cell Transplantation; Male; Medicin och hälsovetenskap; Middle Aged; Prognosis; Viral Load; Virus Activation - drug effects
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood.2019000956

Cytomegalovirus (CMV) reactivation remains one of the most common and life-threatening infectious complications following allogeneic hematopoietic stem cell transplantation, despite novel diagnostic technologies, several novel prophylactic agents, and further improvements in preemptive therapy and treatment of established CMV disease. Treatment decisions for CMV reactivation are becoming increasingly difficult and must take into account whether the patient has received antiviral prophylaxis, the patient's individual risk profile for CMV disease, CMV-specific T-cell reconstitution, CMV viral load, and the potential drug resistance detected at the time of initiation of antiviral therapy. Thus, we increasingly use personalized treatment strategies for the recipient of an allograft with CMV reactivation based on prior use of anti-CMV prophylaxis, viral load, the assessment of CMV-specific T-cell immunity, and the molecular assessment of resistance to antiviral drugs. [Display omitted]