Update on Cytomegalovirus Infection Management in Allogeneic Hematopoietic Stem Cell Transplant Recipients. A Consensus Document of the Spanish Group for Hematopoietic Transplantation and Cell Therapy (GETH-TC)

Fecha de publicación: 31/08/2024

Autores de IIS La Fe

• José Luis Piñana Sánchez

  Autor

• Manuel Nuno Direito De Morais Guerreiro

  Autor

• Carlos Solano Vercet

  Autor

Participantes ajenos a IIS La Fe

• Gimenez, Estela
• Vazquez, Lourdes
• Marcos, Maria Angeles
• Duarte, Rafael
• Perez, Ariadna
• de Miguel, Carlos
• Espigado, Ildefonso
• Gonzalez-Vicent, Marta
• Suarez-Lledo, Maria
• Garcia-Cadenas, Irene
• Martino, Rodrigo
• Cedillo, Angel
• Rovira, Monserrat
• de la Camara, Rafael
• Navarro, David
• Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Grp GETH-TC

Grupos

• Hematología y Hemoterapia

  

  Investigador Principal

  Javier De La Rubia Comos

Abstract

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 hematological patients, focusing on unresolved issues in monitoring, prophylaxis, treatment, resistance. These recommendations aim to guide clinical practice and improve outcomes in high-risk population. Further research is warranted to validate these recommendations address ongoing challenges in CMV management with emerging antiviral combinations, in

Keywords

• CMV; Antiviral prophylaxis; Preemptive antiviral therapy; CMV DNA doubling time; CMV-specific T-Cell immunity; Clinically significant CMV infection