Abstract
Despite an extensive literature, no consensus has emerged regarding the optimal preventive strategy for CMV in allogeneic bone marrow transplantation (BMT). No survey of CMV prevention in BMT centers in the United States has yet been published. A questionnaire was sent to all allogeneic BMT programs in the United States, as listed in the November 1998 National Marrow Donor Program (NMDP) address roster. Questions included whether universal prophylaxis, pre-emptive therapy, or some other strategy was used for CMV prevention, and which CMV diagnostic tests were utilized. Eighty-one of 96 programs (86%) responded to the survey. Of these, 46 (56%) utilize a pre-emptive ganciclovir strategy, whereas 17 (21%) utilize universal prophylaxis, and 15 (19%) utilize a hybrid strategy based on risk stratification. The most commonly utilized CMV diagnostic tests are CMV-DNA by PCR (55 centers), shell vial centrifugation culture (52), tissue culture (42), pp65 antigenemia assay (38), and CMV-DNA by Digene hybrid capture (14). Of these, the CMV-DNA by PCR, pp65 antigenemia assay, and shell vial culture are the most frequently utilized as triggers for pre-emptive therapy. Quantitative assays are common (PCR 42%, Digene 64%). We conclude that centers currently performing allogeneic BMT in the United States employ a variety of strategies for CMV prevention, and differ in their diagnostic tests of choice for CMV monitoring. These results emphasize the need for large-scale studies to identify optimal diagnostic and management protocols. Bone Marrow Transplantation (2000) 26, 763–767.
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References
Meyers JD, Flournoy N, Thomas ED . Risk factors for cytomegalovirus infection after human marrow transplantation J Infect Dis 1986 153: 478–488
Schmidt GM . Prophylaxis of cytomegalovirus infection after bone marrow transplantation Semin Oncol 1992 19: (3 Suppl. 7) 20–26
Holland HK, Saral R . Cytomegaloviral virus infection in bone marrow transplantation recipients: strategies for prevention and treatment Support Care Cancer 1993 1: 245–249
Forman SJ, Zaia JA . Treatment and prevention of cytomegalovirus pneumonia after bone marrow transplantation: where do we stand? Blood 1994 83: 2392–2398
Goodrich JM, Boeckh M, Bowden R . Strategies for the prevention of cytomegalovirus disease after marrow transplantation Clin Infect Dis 1994 19: 287–298
Reusser P . The challenge of cytomegalovirus infection after bone marrow transplantation: epidemiology, prophylaxis, and therapy Bone Marrow Transplant 1996 18: (Suppl 2) 107–109
Tsinontides AC, Bechtel TP . Cytomegalovirus prophylaxis and treatment following bone marrow transplantation Ann Pharmacother 1996 30: 1277–1290
Prentice HG, Kho P . Clinical strategies for the management of cytomegalovirus infection and disease in allogeneic bone marrow transplantation Bone Marrow Transplant 1997 19: 135–142
Adal KA, Avery RK . Prevention of cytomegalovirus infection after allogeneic bone marrow transplantation. In: Bolwell BJ (ed) Current Controversies in Bone Marrow/Stem Cell Transplantation Humana Press: New Jersey 1999 295–316
Ljungman P . Cytomegalovirus pneumonia: presentation, diagnosis, and treatment Semin Respir Infect 1995 10: 209–215
Riddell SR . Pathogenesis of cytomegalovirus pneumonia in immunocompromised hosts Semin Respir Infect 1995 10: 199–208
Torok-Storb B, Simmons P, Khaira D et al. Cytomegalovirus and marrow function Ann Hematol 1992 64: (Suppl.) A128–131
Miller W, Flynn P, McCullough J et al. Cytomegalovirus infection after bone marrow transplantation: an association with acute graft-v-host disease Blood 1986 67: 1162–1167
Emanuel D, Cunninghan I, Jules-Elysee K et al. Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin Ann Intern Med 1988 109: 777–782
Reed EC, Bowden RA, Dandliker PS et al. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants Ann Intern Med 1988 109: 783–788
Schmidt GM, Kovacs A, Zaia JA et al. Ganciclovir/immunoglobulin combination therapy for the treatment of human cytomegalovirus-associated interstitial pneumonia in bone marrow allograft recipients Transplantation 1988 46: 905–907
Ljungman P, Engelhard D, Link H et al. Treatment of interstitial pneumonitis due to cytomegalovirus with ganciclovir and intravenous immune globulin: experience of European Bone Marrow Transplant Group Clin Infect Dis 1992 14: 831–835
Husni RN, Gordon SM, Longworth DL et al. Cytomegalovirus infection is a risk factor for invasive aspergillosis in lung transplant recipients Clin Infect Dis 1998 26: 753–755
Meyers JD, Reed EC, Shepp DH et al. Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic bone marrow transplantation New Engl J Med 1988 318: 70–75
Prentice HG, Gluckman E, Powles RP et al. The impact of long-term acyclovir on cytomegalovirus infection and survival in allogeneic bone marrow transplantation Lancet 1994 343: 749–753
Goodrich JM, Bowden RA, Fisher L et al. Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant Ann Intern Med 1993 118: 173–178
Winston DJ, Ho WG, Bartoni RN et al. Ganciclovir prophylaxis of cytomegalovirus infection and disease in allogeneic bone marrow transplant recipients Ann Intern Med 1993 118: 179–184
Salzberger B, Bowden RA, Fackman RC et al. Neutropenia in allogeneic marrow transplant recipients receiving ganciclovir for prevention of cytomegalovirus disease: risk factors and outcome Blood 1997 90: 2502–2508
Li CR, Greenberg PD, Gilbert MJ et al. Recovery of HLA-restricted cytomegalovirus (CMV)-specific T-cell responses after allogeneic bone marrow transplant: correlation with CMV disease and effect of ganciclovir prophylaxis Blood 1994 83: 1971–1979
Goodrich JM, Mori M, Gleaves CA et al. Early treatment with ganciclovir to prevent cytomegalovirus disease after allogeneic bone marrow transplantation New Engl J Med 1991 325: 1601–1607
Schmidt GM, Horak DA, Niland JC et al. A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants New Engl J Med 1991 324: 1005–1011
Boeckh M, Bowden RA, Goodrich JM et al. Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation Blood 1992 80: 1358–1364
Zaia JA, Schmidt GM Chao NJ et al. Use of preemptive ganciclovir based solely on asymptomatic pulmonary cytomegalovirus infection in marrow transplant recipients – long-term follow-up Blood 1994 84: (10 Suppl. 1) 249a
Einsele H, Enhinger G, Hebart H et al. Polymerase chain reaction monitoring reduces the incidence of cytomegalovirus disease and the duration and side effects of antiviral therapy after bone marrow transplantation Blood 1995 86: 2815–2820
Bacigalupo A, Tedone E, Isaza A et al. CMV-antigenemia after allogeneic bone marrow transplantation: correlation of CMV-antigen positive cell numbers with transplant-related mortality Bone Marrow Transplant 1995 16: 155–161
Boeckh M, Gooley TA, Myerson D et al. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation – a randomized double-blind study Blood 1996 88: 4063–4071
Mandanas RA, Saez RA, Selby GB, Confer DL . Cytomegalovirus surveillance and prevention in allogeneic bone marrow transplantation: examination of a preemptive plan of ganciclovir therapy Am J Hematol 1996 51: 104–111
Ljungman P, Lore K, Aschan J et al. Use of a semi-quantitative PCR for cytomegalovirus DNA as a basis for pre-emptive antiviral therapy in allogeneic bone marrow transplant patients Bone Marrow Transplant 1996 17: 583–587
Hebart H, Muller C, Loffler J et al. Monitoring of CMV infection: a comparison of PCR from whole blood, plasma-PCR, pp65-antigenemia and virus culture in patients after bone marrow transplantation Bone Marrow Transplant 1996 17: 861–868
Nicholson VA, Whimbey E, Champlin R et al. Comparison of cytomegalovirus antigenemia and shell vial culture in allogeneic marrow transplantation recipients receiving ganciclovir prophylaxis Bone Marrow Transplant 1997 19: 37–41
Boeckh M, Gallez-Hawkins GM, Myerson D et al. Plasma polymerase chain reaction for cytomegalovirus DNA after allogeneic marrow transplantation: comparison with polymerase chain reaction using peripheral blood leukocytes, pp65 antigenemia, and viral culture Transplantation 1997 64: 108–113
Atkinson K, Downs K, Golenia M et al. Prophylactic use of ganciclovir in allogeneic bone marrow transplantation: absence of clinical cytomegalovirus infection Br J Haematol 1991 79: 57–62
Von Bueltzingsloewen A, Bordigoni P, Witz F et al. Prophylactic use of ganciclovir for allogeneic bone marrow transplant recipients Bone Marrow Transplant 1993 12: 197–202
Przepiorka D, Ippoliti C, Panini A et al. Ganciclovir three times per week is not adequate to prevent cytomegalovirus reactivation after T-cell depleted marrow transplant Bone Marrow Transplant 1994 13: 461–464
Verdonck LF, Dekker AW, Rozenberg-Arska M, van den Hoek MR . A risk-adapted approach with a short course of ganciclovir to prevent cytomegalovirus (CMV) pneumonia in CMV-seropositive recipients of allogeneic bone marrow transplants Clin Infect Dis 1997 24: 901–907
Takenaka K, Gondo H, Tanimoto K et al. Increased incidence of cytomegalovirus (CMV) infection and CMV-associated disease after allogeneic bone marrow transplantation from unrelated donors Bone Marrow Transplant 1997 19: 241–248
Boeckh M, Bowden RA, Gooley T et al. Successful modification of a pp65 antigenemia-based early treatment strategy for prevention of cytomegalovirus disease in allogeneic marrow transplant recipients (letter) Blood 1999 93: 1781–1782
Ljungman P, Aschan J, Azinge JN et al. Cytomegalovirus viraemia and specific T-helper cell responses as predictors of disease after allogeneic marrow transplantation Br J Haematol 1993 83: 118–124
Walter EA, Greenberg PD, Gilbert MJ et al. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor New Engl J Med 1995 333: 1038–1044
Ljungman P, DeBock R, Cordonnier C et al. Practices for cytomegalovirus diagnosis, prophylaxis, and treatment in allogeneic bone marrow transplant recipients; a report from the Working Party for Infectious Diseases of the EBMT Bone Marrow Transplant 1993 12: 399–403
Erice A, Chow SW, Biron K et al. Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients New Engl J Med 1989 320: 289–293
Reusser P, Cordonnier C, Einsele H et al. European survey of herpesvirus resistance to antiviral drugs in bone marrow transplant recipients Bone Marrow Transplant 1996 17: 813–817
Erice A, Borrell N, Li W et al. Ganciclovir susceptibilities and analysis of UL97 region in cytomegalovirus (CMV) isolates from bone marrow recipients with CMV disease after antiviral prophylaxis J Infect Dis 1998 178: 531–534
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Avery, R., Adal, K., Longworth, D. et al. A survey of allogeneic bone marrow transplant programs in the United States regarding cytomegalovirus prophylaxis and pre-emptive therapy. Bone Marrow Transplant 26, 763–767 (2000). https://doi.org/10.1038/sj.bmt.1702608
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DOI: https://doi.org/10.1038/sj.bmt.1702608
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