Pre-emptive antiviral therapy for active CMV infection in adult allo-SCT patients guided by plasma CMV DNAemia quantitation using a real-time PCR assay: clinical experience at a single center

Spontaneously‐resolving episodes of cytomegalovirus DNAemia in allogeneic hematopoietic stem cell transplant recipients: Virological features and clinical outcomes

“…CMV DNA load monitoring was conducted on a weekly basis starting before conditioning (day 8) through day +100. From day +100 until day +365, patients at risk for recurrent episodes of CMV DNAemia were also monitored on a weekly basis, while the remaining patients were monitored at each planned visit . Plasma CMV DNA levels were monitored twice during episodes of CMV DNAemia for a number of patients at the physician's discretion.…”

“…Currently, PET consists of administrating antivirals with intrinsic activity against CMV upon detection of a certain CMV DNA load level in the blood compartment, as quantified by real‐time polymerase chain reaction (RT‐PCR) assays. CMV DNA load thresholds for PET initiation vary widely across centers, usually ranging between 25 to 1500 IU/mL when plasma is the chosen specimen type . Recently published data point to an association between very low CMV DNA loads (≥250 IU/mL) and increased risk of overall and nonrelapse mortality within the first year of allo‐HSCT, particularly in the early days (day 0–60) after the transplantation .…”

Early Kinetics of Plasma Cytomegalovirus DNA Load in Allogeneic Stem Cell Transplant Recipients in the Era of Highly Sensitive Real-Time PCR Assays: Does It Have Any Clinical Value?

“…Quantitative real-time PCR (qRT-PCR) tests have largely replaced the pp65 antigenemia (AG) assay for guiding antiviral inception, with satisfactory clinical results (1,2,4,5). While in the AG test era, the positivity of the assay triggered the initiation of antiviral therapy, in the qRT-PCR era, the deployment of treatment is delayed until the CMV DNA load in the blood reaches a predetermined threshold.…”

Preemptive antiviral therapy for CMV infection in allogeneic stem cell transplant recipients guided by the viral doubling time in the blood

“…[1][2][3][4][5] The main drawback of this strategy is drug-related toxicity due to overtreatment, whose magnitude ultimately depends upon the CMV DNA load threshold chosen for triggering the initiation of antiviral therapy. 1,2, 4 Emery et al 6 demonstrated the potential clinical value of kinetic analyses of CMV DNAemia in the management of CMV infection in transplant recipients.…”

“…The most relevant characteristics of the patients are shown in Table 1. CMV DNA load monitoring in plasma was performed as previously indicated, 3,5,7 using the new RealTime CMV PCR (Abbott Molecular, Des Plaines, IL, USA), whose limit of detection and quantification is 20 copies/mL (95% confidence interval). 8,9 Antiviral therapy with valganciclovir either at conventional doses (900 mg/12 h) or at reduced doses (450 mg/12 h) in patients meeting one or more of the following criteria: o 50 kg body weight, reduction of the glomerular filtrate ⩽ 60 mL/min per 1.73 m 2 , o1000 neutrophils/μL or o 50 000 platelets/μL, was initiated when the CMV dt was ⩽ 2.0 days, or alternatively when the plasma CMV DNA load reached levels of 41000 copies/mL, whichever occurred first.…”