Info

🌱 來自: Transplant Infection Prevention, Overview

CMV HCT

Primary Regimens

Preemptive Strategy

• Monitor weekly for CMV viremia by PCR (or antigenemia) for 3-6 months post transplant with consideration for more prolonged monitoring in patients at risk for late-onset CMV disease (chronic graft versus host disease (GVHD) requiring systemic treatment, patients receiving high-dose steroids, T-cell depleted or cord blood transplant recipients, and CD4 < 100 cells/mL).
• Start treatment with identification of CMV viremia or antigenemia.

Treatment

• Valganciclovir 900 mg po bid or
• Ganciclovir 5 mg/kg IV q12h until clearance of viremia, but for not less than 2 weeks.
• At that point of viremia clearance, either switch to secondary prophylaxis (below) or resume preemptive approach.

Prophylaxis

• Letermovir 480 mg IV or po q24h
• Valganciclovir 900 mg po q24h (beginning post-engraftment):