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Optimal Strategy for CMV Prevention in HCT

CE / CME

Reducing the Burden of Cytomegalovirus in HCT: Optimal Strategy for Prevention

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurse Practitioners: 1.00 Nursing contact hours, includes 1.00 hour of pharmacotherapy credit

Released: July 21, 2023

Expiration: July 20, 2024

Roy F. Chemaly
Roy F. Chemaly, MD, MPH
CME/CE Information

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Types and Consequences of CMV Disease After HCT

Development of CMV disease after CMV reactivation is associated with high morbidity and requires specific treatment to prevent serious complications. Of most concern is development of CMV end-organ disease in the lungs, gastrointestinal tract, eyes, CNS, and other body systems (Table 1). 1,7 In the era before widespread availability of antiviral therapies, CMV pneumonia was the most common end-organ disease after allo-HCT; today, gastrointestinal disease is the most frequent manifestation and pneumonia is second.

Table 1. End-Organ Diseases with CMV1

End-organ disease can occur at any time after transplant and remains a concern whenever CMV primary infection or reactivation is present. Disease can be categorized as early onset (within 3 months) or late onset (after 3 months) depending on the time since transplantation.1

In addition to the morbidity associated with CMV disease, ongoing CMV infection itself is associated with additional immunosuppression and secondary infections.1 Of more concern, the development of CMV viremia (ie, detectable viral load) is associated by itself with increased overall and nonrelapse mortality during the year after allo-HCT, even when preemptive therapy (PET) is used.8,9 Use of PET reduced risk for CMV end-organ disease vs no PET, and higher viral loads were associated with greater impact on mortality.8 Mortality is increased independent of the underlying hematologic malignancy being treated with transplantation.9 

Therefore, the ideal approach to limit CMV infection following allo-HCT is to control it early or prevent it entirely. The only effective nonpharmacologic strategy for prevention of CMV infection is to match a seronegative donor and seronegative recipient.7 Perhaps counterintuitively, matching a seronegative donor with a seropositive recipient is associated with negative outcomes, including poorer survival.7 With few nonpharmacologic preventive options, 2 pharmacologic strategies are widely used: PET and prophylaxis.10 

Expert Insights From Dr Chemaly: The Impact of CMV Disease/End-organ Disease on Patients’ Lives

Which of these patient factors is mainly associated with increased risk for CMV infection after allo-HCT?

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