Cytomegalovirus infection in the bone marrow transplant patient

Abstract

Cytomegalovirus (CMV) infection is an important contributor to the morbidity and mortality associated with bone marrow transplantation (BMT). Infection may lead to CMV disease involving multiple organs such as pneumonia, gastroenteritis, retinitis, central nervus system involvement and others. CMV seropositivity is an important risk factor and approximately half of BMT recipients will develop clinically significant infection most commonly in the first 100 d post-transplant. The commonly used tests to diagnose CMV infection in these patients include the pp65 antigenemia test and the CMV DNA polymerase chain reaction (PCR) assay. Because of its greater sensitivity and lesser turnaround time, the CMV PCR is nowadays the preferred test and serves as a main guide for pre-emptive therapy. Methods of CMV prevention include use of blood products from seronegative donors or leukodepleted products. Prophylaxis or pre-emptive therapy strategies for CMV prevention may be used post-transplant with the latter becoming more common. The commonly used antivirals for pre-emptive therapy and CMV disease management include intravenous gancyclovir and foscarnet. The role of intravenous immunoglobulin, although used commonly in CMV pneumonia is not clear.

Management of Patients With Hepatitis C Virus, Monoclonal Gammopathy of Undetermined Significance, and Multiple Myeloma

“…Recurrence of viremia after BM or solid organ transplantation is well described with many viruses, including, but not limited to, cytomegalovirus, 22 Epstein-Barr virus, 23,24 and hepatitis B. 25,26 However, we were unable to find any reports of a patient auto-infecting oneself with HCV from previously harvested stem cells.…”

Detection of antibody-secreting cells specific for the cytomegalovirus and herpes simplex virus surface antigens

“…Infections with HSV or HCMV may lead to severe or even lifethreatening diseases in immunocompromised patients or when acquired at birth (HSV) or during pregnancy (HCMV) (Berrington et al, 2009;Bhat et al, 2015;Boppana et al, 2013;Thompson and Whitley, 2011). Antivirals are available but may lead to the development of resistance (Minces et al, 2014;Morfin and Thouvenot, 2003) or are contraindicated for the treatment during pregnancy due to potential teratogenic side effects (Kimberlin, 2001).…”

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

“…Los medicamentos alternos ante resistencia son cidofovir y foscarnet. 201,202,203,204,205,206,207 Dada la complejidad de la respuesta inmune del huésped contra el CMV, en la que participa activamente la respuesta inmune celular y humoral, innata y adaptativa, se han realizado estudios con inmunoglobulina humana específica para CMV que han mostrado que esta inmunoglobulina puede tener mejor efecto inmunomodulador. 201,202,203,204,207 También se ha informado su uso en resistencia del CMV a ganciclovir.…”