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

Abstract

Abbreviations: aGVHD = acute GvHD; cLPS = common lymphoid precursors; D = donor; MDS = myelodysplastic syndrome; R = recipient.Bone Marrow Transplantation (2016) 51, 718-721

Community‐acquired respiratory virus lower respiratory tract disease in allogeneic stem cell transplantation recipient: Risk factors and mortality from pulmonary virus‐bacterial mixed infections

“…ganciclovir, or i.v. foscarnet upon detection of CMV DNA levels exceeding 1500 IU/mL or a CMV DNA doubling time ≤2 days, as previously reported . In turn, a universal prophylaxis strategy was used at HLF until December 2016 .…”

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.…”

“…Plasma CMV DNA levels were monitored twice during episodes of CMV DNAemia for a number of patients at the physician's discretion. Antiviral therapy with (val)ganciclovir or foscarnet at conventional doses was initiated when the plasma CMV DNA load reached levels of ≥1500 IU/mL, or when the CMV doubling time (dt) was ≤2 days, whichever occurred first (this latter strategy since May 2014) …”

“…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 .…”

How to Best Manage Cytomegalovirus Infection in the Allogeneic Stem Cell Transplant Setting: Future Prospects

“…In effect, we recently showed that a CMV DNA load doubling time (dt) ≤2 days, anticipated the eventual need of preemptive antiviral with a positive predictive value of 100% [13]. We later reported that treating patients upon dt s ≤2 days led to a significant reduction of the time on antiviral therapy [14]. In addition, we proved [15] that the CMV DNA dt may be a valuable parameter for interassay and inter-institutional results comparison since QRT-PCR assays show linearity above their limit of quantification, with slope coefficients that vary minimally when testing standard calibration panels [9].…”