Piñana José Luis, Giménez Estela, Vázquez Lourdes, Marcos María Ángeles, Guerreiro Manuel, Duarte Rafael, Pérez Ariadna, de Miguel Carlos, Espigado Ildefonso, González-Vicent Marta, Suarez-Lledó María, García-Cadenas Irene, Martino Rodrigo, Cedillo Angel, Rovira Monserrat, de la Cámara Rafael, Navarro David, Solano Carlos
Hematology Service, Hospital Clinico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain.
Microbiology Service, Hospital Clinico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain.
Mediterr J Hematol Infect Dis. 2024 Sep 1;16(1):e2024065. doi: 10.4084/MJHID.2024.065. eCollection 2024.
Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in patients receiving novel hematological therapies. Its impact on morbidity and mortality necessitates effective management strategies. Despite recent advances in diagnostics and treatment, unresolved questions persist regarding monitoring and treatment, prompting the need for updated recommendations.
A consensus was reached among a panel of experts selected for their expertise in CMV research and clinical practice. Key clinical areas and questions were identified based on previous surveys and literature reviews. Recommendations were formulated through consensus and graded using established guidelines.
Recommendations were provided for virological monitoring, including the timing and frequency of CMV DNAemia surveillance, especially during letermovir (LMV) prophylaxis. We evaluated the role of CMV DNA load quantification in diagnosing CMV disease, particularly pneumonia and gastrointestinal involvement, along with the utility of specific CMV immune monitoring in identifying at-risk patients. Strategies for tailoring LMV prophylaxis, managing breakthrough DNAemia, and implementing secondary prophylaxis in refractory cases were outlined. Additionally, criteria for initiating early antiviral treatment based on viral load dynamics were discussed.
The consensus provides updated recommendations for managing CMV infection in hematological patients, focusing on unresolved issues in monitoring, prophylaxis, treatment, and resistance. These recommendations aim to guide clinical practice and improve outcomes in this high-risk population. Further research is warranted to validate these recommendations and address ongoing challenges in CMV management with emerging antiviral combinations, particularly in pediatric populations.
巨细胞病毒（CMV）感染是异基因造血干细胞移植（allo-HSCT）后以及接受新型血液学治疗的患者中常见的并发症。其对发病率和死亡率的影响需要有效的管理策略。尽管在诊断和治疗方面取得了最新进展，但在监测和治疗方面仍存在未解决的问题，这促使需要更新建议。
在一组因其在CMV研究和临床实践方面的专业知识而被挑选出来的专家之间达成了共识。根据先前的调查和文献综述确定了关键临床领域和问题。通过共识制定建议，并使用既定指南进行分级。
提供了病毒学监测的建议，包括CMV血症监测的时间和频率，特别是在使用来特莫韦（LMV）预防期间。我们评估了CMV DNA载量定量在诊断CMV疾病，特别是肺炎和胃肠道受累方面的作用，以及特定CMV免疫监测在识别高危患者中的效用。概述了调整LMV预防、处理突破性血症以及在难治性病例中实施二级预防的策略。此外，还讨论了基于病毒载量动态启动早期抗病毒治疗的标准。
该共识为血液学患者的CMV感染管理提供了更新的建议，重点关注监测、预防、治疗和耐药性方面未解决的问题。这些建议旨在指导临床实践并改善这一高危人群的治疗结果。有必要进行进一步研究以验证这些建议，并应对CMV管理中使用新兴抗病毒联合疗法持续存在的挑战，特别是在儿科人群中。
