UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS
Background: Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in patients receiving novel hematological therapies. Its impact on morbidity and mortality necessitates effective management strategies. Despite recent ad...
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| Language: | English |
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PAGEPress Publications
2024-08-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | https://www.mjhid.org/mjhid/article/view/5745 |
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| author | José Luis Piñana Estela Giménez Lourdes Vázquez María Ángeles Marcos Manuel Guerreiro Rafael Duarte Ariadna Pérez Carlos de Miguel Ildefonso Espigado Marta González-Vicent María Suarez-Lledó Irene García-Cadenas Rodrigo Martino Angel Cedillo Monserrat Rovira Rafael de la Cámara David Navarro Carlos Solano |
| author_facet | José Luis Piñana Estela Giménez Lourdes Vázquez María Ángeles Marcos Manuel Guerreiro Rafael Duarte Ariadna Pérez Carlos de Miguel Ildefonso Espigado Marta González-Vicent María Suarez-Lledó Irene García-Cadenas Rodrigo Martino Angel Cedillo Monserrat Rovira Rafael de la Cámara David Navarro Carlos Solano |
| author_sort | José Luis Piñana |
| collection | DOAJ |
| description | Background: Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in patients receiving novel hematological therapies. Its impact on morbidity and mortality necessitates effective management strategies. Despite recent advances in diagnostics and treatment, unresolved questions persist regarding monitoring and treatment, prompting the need for updated recommendations.
Methods: A consensus was reached among a panel of experts selected for their expertise in CMV research and clinical practice. Key clinical areas and questions were identified based on previous surveys and literature reviews. Recommendations were formulated through consensus and graded using established guidelines.
Results: Recommendations were provided for virological monitoring, including the timing and frequency of CMV DNAemia surveillance, especially during letermovir (LMV) prophylaxis. We evaluated the role of CMV DNA load quantification in diagnosing CMV disease, particularly pneumonia and gastrointestinal involvement, along with the utility of specific CMV immune monitoring in identifying at-risk patients. Strategies for tailoring LMV prophylaxis, managing breakthrough DNAemia, and implementing secondary prophylaxis in refractory cases were outlined. Additionally, criteria for initiating early antiviral treatment based on viral load dynamics were discussed.
Conclusion: The consensus provides updated recommendations for managing CMV infection in hematological patients, focusing on unresolved issues in monitoring, prophylaxis, treatment, and resistance. These recommendations aim to guide clinical practice and improve outcomes in this high-risk population. Further research is warranted to validate these recommendations and address ongoing challenges in CMV management with emerging antiviral combinations, particularly in pediatric populations.
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| format | Article |
| id | doaj-art-93399f1e240b4f2e90dc2769016881f2 |
| institution | Kabale University |
| issn | 2035-3006 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-93399f1e240b4f2e90dc2769016881f22025-02-03T11:44:24ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062024-08-0116110.4084/MJHID.2024.065UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTSJosé Luis Piñana0Estela Giménez1Lourdes Vázquez2María Ángeles Marcos3Manuel Guerreiro4Rafael Duarte5Ariadna Pérez6Carlos de Miguel7Ildefonso Espigado8Marta González-Vicent9María Suarez-Lledó10Irene García-Cadenas11Rodrigo Martino12Angel Cedillo13Monserrat Rovira14Rafael de la Cámara15David Navarro16Carlos Solano17https://orcid.org/0000-0003-3702-0817Hematology Service. Hospital Clinico Universitario, INCLIVA Biomedical Research Institute-, Valencia, SpainMicrobiology Service, Hospital Clinico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain.Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, SpainMicrobiology Service, Hospital Clinic. Barcelona, SpainHematology Service, Hospital Universitario y Politécnico La Fe. Health Research, Valencia, SpainHematology Service, Hospital Universitario Puerta de Hierro, Madrid, Spain Hematology Service, Hospital Clinico Universitario, INCLIVA Biomedical Research Institute-, Valencia, Spain.Hematology Service, Hospital Universitario Puerta de Hierro, Madrid, SpainHematology Service, Hospital Universitario Virgen del Rocío, Sevilla, SpainOnco/Hematology and Transplant Department, Hospital Niño Jesús, Madrid, SpainBMT Unit, Haematology Department, Institute of Haematology and Oncology, IDIBAPS, Hospital clinic, University of Barcelona, Barcelona, Spain. Josep Carreras Leukaemia Research Foundation.Hematology Service. Hospital de la Santa Creu i Sant Pau, Barcelona, SpainHematology Service. Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSpanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH-TC) Secretary, Madrid, SpainBMT Unit, Haematology Department, Institute of Haematology and Oncology, IDIBAPS, Hospital clinic, University of Barcelona, Barcelona, Spain. Josep Carreras Leukaemia Research FoundationHematology Service. Hospital Universitario de La Princesa, Madrid, Spain.Microbiology Service, Hospital Clinico Universitario, INCLIVA Biomedical Research Institute, Valencia, SpainHematology Service. Hospital Clinico Universitario. University of Valencia. Valencia. SpainBackground: Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in patients receiving novel hematological therapies. Its impact on morbidity and mortality necessitates effective management strategies. Despite recent advances in diagnostics and treatment, unresolved questions persist regarding monitoring and treatment, prompting the need for updated recommendations. Methods: A consensus was reached among a panel of experts selected for their expertise in CMV research and clinical practice. Key clinical areas and questions were identified based on previous surveys and literature reviews. Recommendations were formulated through consensus and graded using established guidelines. Results: Recommendations were provided for virological monitoring, including the timing and frequency of CMV DNAemia surveillance, especially during letermovir (LMV) prophylaxis. We evaluated the role of CMV DNA load quantification in diagnosing CMV disease, particularly pneumonia and gastrointestinal involvement, along with the utility of specific CMV immune monitoring in identifying at-risk patients. Strategies for tailoring LMV prophylaxis, managing breakthrough DNAemia, and implementing secondary prophylaxis in refractory cases were outlined. Additionally, criteria for initiating early antiviral treatment based on viral load dynamics were discussed. Conclusion: The consensus provides updated recommendations for managing CMV infection in hematological patients, focusing on unresolved issues in monitoring, prophylaxis, treatment, and resistance. These recommendations aim to guide clinical practice and improve outcomes in this high-risk population. Further research is warranted to validate these recommendations and address ongoing challenges in CMV management with emerging antiviral combinations, particularly in pediatric populations. https://www.mjhid.org/mjhid/article/view/5745CytomegalovirusCMV monitoringantiviral prophylaxispreemptive antiviral therapyCMV DNA doubling timeCMV-specific T-cell immunity |
| spellingShingle | José Luis Piñana Estela Giménez Lourdes Vázquez María Ángeles Marcos Manuel Guerreiro Rafael Duarte Ariadna Pérez Carlos de Miguel Ildefonso Espigado Marta González-Vicent María Suarez-Lledó Irene García-Cadenas Rodrigo Martino Angel Cedillo Monserrat Rovira Rafael de la Cámara David Navarro Carlos Solano UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS Mediterranean Journal of Hematology and Infectious Diseases Cytomegalovirus CMV monitoring antiviral prophylaxis preemptive antiviral therapy CMV DNA doubling time CMV-specific T-cell immunity |
| title | UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS |
| title_full | UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS |
| title_fullStr | UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS |
| title_full_unstemmed | UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS |
| title_short | UPDATE ON CYTOMEGALOVIRUS INFECTION MANAGEMENT IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS |
| title_sort | update on cytomegalovirus infection management in allogeneic hematopoietic stem cell transplant recipients |
| topic | Cytomegalovirus CMV monitoring antiviral prophylaxis preemptive antiviral therapy CMV DNA doubling time CMV-specific T-cell immunity |
| url | https://www.mjhid.org/mjhid/article/view/5745 |
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