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Review
. 2025 Mar;57(1):38-44.
doi: 10.3947/ic.2024.0140.

How Should Cytomegalovirus Infection Be Managed in Allogeneic Hematopoietic Stem Cell Transplant Recipients? A Clinical Grand Round

Dukhee Nho  1   2   3 , Raeseok Lee  1   2   3 , Sung-Yeon Cho  1   2   3 , Dong-Gun Lee  1   2   4
Affiliations
Review

How Should Cytomegalovirus Infection Be Managed in Allogeneic Hematopoietic Stem Cell Transplant Recipients? A Clinical Grand Round

Dukhee Nho et al. Infect Chemother. 2025 Mar.

Abstract

Cytomegalovirus (CMV) is a significant concern for patients with allogeneic hematopoietic cell transplantation (allo-HCT). CMV management differs between institutions due to the lack of local guidelines. Here, we describe a case of refractory/resistant CMV infection treated using our institution's CMV management protocol. A 59-year-old woman who underwent allo-HCT was treated for CMV reactivation. Despite 3 months of valganciclovir administration, serum CMV level surged. CMV gene mutation test revealed a ganciclovir-resistant A594V mutation in the UL97 gene. Treatment was switched to foscarnet until the drug became unavailable nationwide. During the foscarnet shortage, cidofovir was used, leading to a decline in CMV levels when foscarnet was reintroduced and used for 2 months. Following allo-HCT, CMV prophylaxis with letermovir is crucial to prevent reactivation in seropositive recipients. CMV titers should be monitored frequently after allo-HCT. The cutoff value for preemptive therapy varies across institutions, with ganciclovir/valganciclovir usually administered as first-line therapy. Maribavir is an option in cases of ganciclovir/valganciclovir resistance or intolerance. CMV gene mutations should be examined in patients with suspected resistance after 2 weeks of appropriate treatment. This case was discussed at the Clinical Grand Round of the Annual Conference of the Korean Society of Infectious Diseases on November 2, 2023.

Keywords: Antibiotic prophylaxis; Cytomegalovirus; Hematopoietic stem cell transplantation.

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Conflict of interest statement

DGL is editorial board member of the Journal Infect Chemother; however, he did not involve in the peer reviewer selection, evaluation, and decision process of this article. Otherwise, no potential conflicts of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. Patient’s clinical course.
CDV, cidofovir; FK, tacrolimus; LMV, letermovir; VGCV, valganciclovir; FOS, foscarnet.
Figure 2
Figure 2. Catholic Hematology Hospital CMV management protocol.
CMV, cytomegalovirus; HCT, hematopoietic cell transplantation; GI, gastrointestinal; AEs, adverse events; PCR, polymerase chain reaction; LLoD, lower limit of detection; OPD, outpatient department.
Figure 3
Figure 3. Surveys conducted at the Clinical Grand Round of the Korean Society of Infectious Disease conference in 2023.
CMV, cytomegalovirus.
See this image and copyright information in PMC

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References

    1. Teira P, Battiwalla M, Ramanathan M, Barrett AJ, Ahn KW, Chen M, Green JS, Saad A, Antin JH, Savani BN, Lazarus HM, Seftel M, Saber W, Marks D, Aljurf M, Norkin M, Wingard JR, Lindemans CA, Boeckh M, Riches ML, Auletta JJ. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis. Blood. 2016;127:2427–2438. - PMC - PubMed
    1. Ljungman P, de la Camara R, Robin C, Crocchiolo R, Einsele H, Hill JA, Hubacek P, Navarro D, Cordonnier C, Ward KN 2017 European Conference on Infections in Leukaemia group. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7) Lancet Infect Dis. 2019;19:e260–e272. - PubMed
    1. Yong MK, Shigle TL, Kim YJ, Carpenter PA, Chemaly RF, Papanicolaou GA. American Society for Transplantation and Cellular Therapy Series: #4 - Cytomegalovirus treatment and management of resistant or refractory infections after hematopoietic cell transplantation. Transplant Cell Ther. 2021;27:957–967. - PubMed
    1. Choi R, Lee S, Lee SG, Lee EH. Seroprevalence of CMV IgG and IgM in Korean women of childbearing age. J Clin Lab Anal. 2021;35:e23716. - PMC - PubMed
    1. Choi SR, Kim KR, Kim DS, Kang JM, Kim SJ, Kim JM, Oh Sy, Kang CI, Chung DR, Peck KR, Kang ES, Kim YJ. Changes in cytomegalovirus seroprevalence in Korea for 21 years: a single center study. Pediatr Infect Vaccine. 2018;25:123–131.