Table 3.

Guidelines for CMV management in SCT: Prevention of CMV disease in allogeneic-SCT. ECIL recommendations⁶⁸

Diagnosis The diagnosis of CMV disease must be based on symptoms and signs consistent with CMV disease together with detection of CMV by an appropriate method applied to a specimen from the involved tissue (A II) ○ Symptoms of organ involvement + CMV detection in blood are not enough for diagnosis of CMV disease PCR is usually not appropriate for documentation of CMV disease in tissue specimens, as the PPV is too low (B III)

Monitoring All allogeneic-SCT patients, regardless of whether they receive CMV prophylaxis, should be monitored for CMV in peripheral blood at least weekly using either CMV antigenemia assay or a technique for the detection of either CMV DNA or RNA (AI). Use of a quantitative assay gives additional information valuable for patient management (B II). The duration of monitoring should be at least 100 days (BIII). Longer monitoring is recommended in patients with acute or chronic GVHD, in those having experienced CMV infection after SCT earlier and in those having undergone mismatched or unrelated donor transplantation (BII).

Prevention The strategy of choice: pre-emptive therapy ○ Pre-emptive antiviral therapy based on detection of CMV antigen or nucleic acid (A I) ○ Either intravenous ganciclovir or foscarnet can be used for first line pre-emptive therapy (A I) ○ Valganciclovir might be used in place of i.v. agents especially in low-risk patients (provisional BII). ○ Cidofovir can be considered for second-line pre-emptive therapy (3–5 mg/kg) but careful monitoring of renal function is required (BII). Prophylaxis ○ Iv ganciclovir prophylaxis could be used in sub-groups of patients at high risk for CMV disease (BI) (not specified). ○ Acyclovir or valacyclovir can be used as prophylaxis against CMV in allo-SCT patients (BI). However, their use must be combined with monitoring and the use of pre-emptive therapy (AI). ○ Immune globulin has no role as prophylaxis against CMV infection (EII). Adoptive cellular immunotherapy ○ Infusion of CMV specific lymphocytes or Dendritic cell vaccination are interesting options and should undergo controlled prospective clinical trials (C II)