How I treat CMV reactivation after allogeneic hematopoietic stem cell transplantation

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 t...

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Bibliographic Details
Published in:Blood 2020-05, Vol.135 (19), p.1619-1629
Main Authors: Einsele, Hermann, Ljungman, Per, Boeckh, Michael
Format: Article
Language:English
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
Middle Aged
Prognosis
Viral Load
Virus Activation - drug effects
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Summary: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]
ISSN:0006-4971
1528-0020
DOI:10.1182/blood.2019000956