How I treat CMV reactivation after allogeneic hematopoietic stem cell transplantation.

CMV reactivation remains one of the most common and life-threatening infectious complications following allogeneic hematopoietic stem cell transplantation (allo-HCT) in spite of novel diagnostic technologies, several novel prophylactic agents and further improvement in preemptive therapy and treatment for established CMV disease. Today treatment decisions for CMV reactivation are becoming increasingly difficult and have to consider whether the patient has received antiviral prophylaxis, the patient`s individual risk profile for CMV disease, CMV-specific T cell reconstitution as well as both the CMV viral load and the potential drug-resistance detected at the time of initiation of antiviral therapy. Thus, we increasingly use personalized treatment strategies for the recipient of an allograft with CMV reactivation based on prior use of anti-CMV prophylaxis, viral load, the assessment of CMV-specific T cell immunity, and the molecular assessment of resistance to antiviral drugs.

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