TABLE 1.
Summary of observational studies assessing the potential application of CMV-CMI monitoring in different clinical scenarios.
| Clinical scenario | Predicted event | Supporting studies | Monitoring method | Proposed intervention |
|---|---|---|---|---|
| High-risk patients (D+/R−, T-cell-depleting antibodies, lung transplantation) during antiviral prophylaxis or at the time of discontinuation | Late-onset disease a | Yes [43, 46, 48–58] | QTF-CMV, ELISpot | Prolong antiviral prophylaxis or close monitoring for viremia if inadequate response |
| Pre-transplant assessment in intermediate-risk patients (R+ with no other factors) | Post-transplant viremia and/or disease | Yes [4, 44, 47, 51, 59, 60] | QTF-CMV, ELISpot, ICS | Initiate antiviral prophylaxis or close monitoring for viremia in patients with inadequate response (D+/RNR) |
| Intermediate-risk patients (R+) on preemptive therapy with no concurrent viremia | Subsequent viremia and/or disease | Yes [42, 44, 49, 51, 52, 61–64] | ICS, QTF-CMV, ELISpot, MHC-tetramer staining | Reduce the frequency and/or discontinue monitoring of viremia if adequate response |
| Intermediate-risk patients (R+) on preemptive therapy with asymptomatic viremia | Spontaneous clearance | Yes [65, 66] | QTF-CMV | Withhold antiviral therapy if adequate response |
| Active CMV infection or disease during antiviral treatment | Response to antiviral treatment | No | Decrease immunosuppression and/or modify antivirals if inadequate response | |
| Active CMV infection or disease after discontinuation of antiviral treatment | Post-treatment relapse | Yes [67] | ICS | Initiate secondary prophylaxis if inadequate response |
| Acute graft rejection treated with steroid boluses and/or T-cell-depleting antibodies | Disease following anti-rejection therapy | No | (Re)initiate prophylaxis if inadequate response |
CMV, cytomegalovirus; D, donor; ELISpot, enzyme-linked immunosorbent spot assay; ICS, intracellular cytokine staining; QTF-CMV, QuantiFERON-CMV assay; MHC, major histocompatibility complex; R, recipient.
a
Refers to the occurrence of CMV, disease after discontinuing antiviral prophylaxis with ganciclovir or valganciclovir (usually administered for 100–200 days).