Assessment and prevention of cytomegalovirus infection in allogeneic hematopoietic stem cell transplant and in solid organ transplant: A multidisciplinary consensus conference by the Italian GITMO, SITO, and AMCLI societies

Abstract

Cytomegalovirus (CMV) remains a major cause of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT) recipients. In view of the uncertainties on the assessment and prevention of CMV infection in both transplant procedures, three Italian scientific societies for HSCT and SOT and for Clinical Microbiology appointed a panel of experts to compose a framework of recommendations. Recommendations were derived from a comprehensive analysis of the scientific literature and from a multidisciplinary consensus conference process. The lack of adequate clinical trials focused on certain

Advances in CMV Management: A Single Center Real-Life Experience

“…The attention of the transplant community on CMV is particularly high, and recently the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) published a guideline addressing the major points of CMV management (Girmenia et al, 2019). Nevertheless, the real-life policy of CMV management is still heterogeneous in this transition period, considering that letermovir has been recently registered for CMV prophylaxis (Marty et al, 2017) and that CMV DNA monitoring from WB instead of PL for definition of the CMV clinically significant infection has been proposed to be preferable, even though not definitively demonstrated and largely applied (Lazzarotto et al, 2018).…”

“…Before the availability of letermovir, the management of CMV infection was based on the monitoring of CMV DNAemia by RT-qPCR and on the prompt use of pre-emptive therapy (PET), either with foscarnet, ganciclovir, or valganciclovir. CMV DNA cut-off values for PET are still a matter of debate: Italian guidelines suggest more than 1,000 copies/ml in plasma (PL) or 10,000 copies/ml in whole blood (WB), in two consecutive assessments (Girmenia et al, 2019), while the ECIL-7 guidelines suggest that it should be adapted according to the monitoring technique used at the transplant center (Ljungman et al, 2019). PET is generally continued for at least 2 weeks, and stopped after at least one (Ljungman et al, 2019) or preferably two consecutive negative tests (Girmenia et al, 2019).…”

“…CMV DNA cut-off values for PET are still a matter of debate: Italian guidelines suggest more than 1,000 copies/ml in plasma (PL) or 10,000 copies/ml in whole blood (WB), in two consecutive assessments (Girmenia et al, 2019), while the ECIL-7 guidelines suggest that it should be adapted according to the monitoring technique used at the transplant center (Ljungman et al, 2019). PET is generally continued for at least 2 weeks, and stopped after at least one (Ljungman et al, 2019) or preferably two consecutive negative tests (Girmenia et al, 2019). Although anti-CMV hyper-immunoglobulins (Megalotect) can be safely used (Malagola et al, 2019), no conclusive data are available to recommend a routine use, and both the ECIL-7 guidelines and the Italian guidelines do not recommend the routine use of anti-CMV hyper-immunoglobulins (Girmenia et al, 2019;Ljungman et al, 2019).…”

“…PET is generally continued for at least 2 weeks, and stopped after at least one (Ljungman et al, 2019) or preferably two consecutive negative tests (Girmenia et al, 2019). Although anti-CMV hyper-immunoglobulins (Megalotect) can be safely used (Malagola et al, 2019), no conclusive data are available to recommend a routine use, and both the ECIL-7 guidelines and the Italian guidelines do not recommend the routine use of anti-CMV hyper-immunoglobulins (Girmenia et al, 2019;Ljungman et al, 2019).…”

“…During the last few years, the laboratory monitoring of CMV and the diagnosis of CMV infection moved from CMV antigenemia (Cariani et al, 2007) to molecular quantitative RT-qPCR (Girmenia et al, 2019;Ljungman et al, 2019), but a unique standardized method for detection of DNAemia has not been defined yet. Even though it is true that both WB and PL are valid sources for CMV DNA monitoring after allo-SCT, recently, WB has been suggested to be more reliable than PL as a source for RT-qPCR.…”