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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

CME/CE Information

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PET for CMV

PET is based on the concept of weekly (or twice weekly) monitoring for CMV reactivation for up to 100 days after transplant, using quantitative polymerase chain reaction (qPCR) to check CMV viral load. The aim is to prevent progression to CMV end-organ disease. The CMV viral load that triggers therapy varies among transplant centers, but typically ranges from about 150 to 1500 IU/mL depending on the patient’s risk status.7,13 In essence, PET is predicated upon monitoring CMV reactivation and then intervening early to prevent development of CMV disease.7 

Of the 2 common methods for monitoring CMV viral levels, the ASTCT prefers qPCR over pp65 antigen testing because of PCR’s greater sensitivity. When required, all PET starts with induction dosing and then transitions to secondary prophylaxis (the term preferred by ASTCT) with viral clearance or significant reduction in viral load.7 Dosages used in secondary prophylaxis generally are lower than induction, which may mitigate treatment toxicity.

Ganciclovir or valganciclovir are the preferred first-line choices for PET and are usually effective.2,13 Of these agents, only ganciclovir is FDA approved for CMV-related uses in patients after allo-HCT; valganciclovir is approved after solid organ transplant.7,14,15 Treatment duration is usually between 2 to 3 weeks or until CMV viral load is undetectable.13

What is the key time period for development of neutropenia with ganciclovir treatment?

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