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When should preemptive antiviral therapy for active CMV infection be withdrawn from allogeneic stem cell transplant recipients?

Bone Marrow Transplantation volume 52, pages 1448–1451 (2017)Cite this article

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Preemptive antiviral therapy guided by the viral load present in patient blood (measured by quantitative real-time PCR assays) is currently the mainstay strategy for the prevention of CMV end-organ disease in the allogeneic stem cell transplantation (allo-SCT) setting.1 Although the effectiveness of this preventative therapeutic approach is beyond doubt, the occurrence of recurrent episodes of CMV DNAemia remains a problem as the incidence rates can still exceed 50% of patients in certain allo-SCT modalities.2

Available guideline recommendations and expert opinions on CMV infection management in allo-SCT recipients are rather imprecise about when preemptive antiviral treatment should be interrupted.3, 4, 5, 6, 7 A recent national survey revealed wide variation in the criterion for preemptive antiviral therapy cessation across Spanish allo-SCT transplant programs,8 a scenario which is also likely to occur in transplant centers in other countries. It is common practice to withdraw antiviral therapy after documentation of either one or two consecutive negative PCR results (undetectable CMV DNA load) after a minimum of 2 weeks of therapy, although no data currently support the preferential use of one strategy over the other. In this study, we investigated the potential effect of the length of antiviral treatment courses for primary (initial) episodes of CMV DNAemia on the incidence of recurrences.

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Acknowledgements

EG holds a Rio Hortega research contract from the Instituto de Salud Carlos III. This research was supported in part by a grant (12/01992) from the FIS (Health Research Fund; Fondo de Investigaciones Sanitarias in its original Spanish), ISCIIII.

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Authors and Affiliations

  1. Hematology Service, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain

    C Solano, J L Piñana, J C Hernández-Boluda & P Amat

  2. Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain

    C Solano

  3. Microbiology Service, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain

    E Giménez, V Vinuesa & D Navarro

  4. Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain

    D Navarro

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  1. C Solano
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  2. E Giménez
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  5. P Amat
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  6. V Vinuesa
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  7. D Navarro
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Correspondence to D Navarro.

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Solano, C., Giménez, E., Piñana, J. et al. When should preemptive antiviral therapy for active CMV infection be withdrawn from allogeneic stem cell transplant recipients?. Bone Marrow Transplant 52, 1448–1451 (2017). https://doi.org/10.1038/bmt.2017.109

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