HSV for tumour lysis

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Advances in the prevention and treatment of CMV

Presented by R Razonable, Mayo Clinic, Rochester, Minnesota, USA.

Cytomegalovirus (CMV) is a leading cause of infectious complication after solid organ (SOT) and haematopoietic stem cell transplantation (HSCT). The magnitude of its direct and indirect negative impact on the outcome of transplantation has made CMV prevention an essential component in the care of all transplant patients. The most widely implemented method of CMV prevention is the use of antiviral drugs, either as prophylaxis or pre-emptive therapy, during the early period after transplantation when the degree of immunosuppression is most intense and the risk of CMV reactivation and primary infection is highest. Randomized controlled clinical trials that evaluated the use of ganciclovir, high-dose aciclovir, valaciclovir, foscarnet and valganciclovir have shown the efficacy of these drugs in significantly reducing the incidence of CMV during the early post-transplant period. However, a subset of patients, particularly CMV D+/R- SOT patients and CMV R+ HSCT patients, remain at an increased risk upon discontinuation of antiviral prophylaxis. The management of this group of patients has emerged as an important challenge, as some cases involve infection with drug-resistant CMV. The standard treatment for CMV disease is intravenous ganciclovir; valganciclovir may offer an option for oral therapy in selected patients. CMV or polyvalent immunoglobulin may also be added for certain indications. Foscarnet, cidofovir, and foscarnet-ganciclovir combination are options for treating ganciclovir-resistant CMV. The duration of treatment is 2–4 weeks, and the use of sensitive assays (i.e. polymerase chain reaction or antigenemia) may further guide an individualized duration of therapy.

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Last Updated : 14/04/2004 10:42:46