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American Society for Transplantation and Cellular Therapy Series #11: Updated Cytomegalovirus Guidelines in
Fareed Khawaja1, Daniel Zamora2, Michelle K Yong3
1Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Insights
This update provides new guidance on preventing and treating cytomegalovirus (CMV) infection after hematopoietic cell transplantation (HCT). It covers novel antiviral treatments and expanded use of existing therapies for diverse patient groups.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Hematology
Background:
- Previous guidelines for cytomegalovirus (CMV) infection post-hematopoietic cell transplantation (HCT) were updated in 2021.
- Advances in CMV prevention and management necessitate further guideline revisions.
- This series utilizes a frequently asked questions (FAQs) format for clinical providers.
Purpose of the Study:
- To update guidelines on CMV prevention and management following HCT.
- To address new antiviral treatments and expanded indications for existing therapies.
- To provide guidance for special populations, including CAR T-cell therapy recipients and pediatric transplant patients.
Main Methods:
- Collaboration between the American Society of Transplantation and Cellular Therapy's Practice Guidelines Committee and Transplant Infectious Diseases Special Interest Group.
- Development of FAQs by adult and pediatric infectious diseases and HCT experts.
- Grading of recommendations based on strength (A-E) and evidence level (I-III).
Main Results:
- Focus on new antiviral treatments for CMV.
- Expanded indications for existing antiviral prophylaxis.
- Specific considerations for CMV management in CAR T-cell therapy and pediatric HCT recipients.
Conclusions:
- The updated guidelines incorporate recent advancements in CMV therapeutics.
- Guidance is provided for the evolving landscape of CMV prevention and treatment in HCT.
- The FAQs format aims to enhance clinical applicability and accessibility of recommendations.
Abstract:
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy partnered with the society's Transplant Infectious Diseases Special Interest Group to update its previous infectious disease guidelines for the prevention and management of cytomegalovirus (CMV) infection and disease following hematopoietic cell transplantation (HCT). The two updates, published in 2021, focused on the prevention and management of CMV infection, respectively, including refractory and resistant CMV infections. To best serve clinical providers, each standalone topic in the infectious diseases series has been published in a concise format of frequently asked questions (FAQs). Adult and pediatric infectious diseases and HCT content experts developed the FAQs and the answers; recommendations were graded according to their strength (A-E) and the level of the supporting evidence (I-III). Several advances in CMV prevention and management since 2021 warranted an update to the original third and fourth topics in the series. This eleventh topic in the series focuses on new antiviral treatments for CMV, expanded indications of existing antiviral therapy for the prevention of CMV, and the treatment of CMV in special populations such as CAR T-cell therapy recipients and pediatric transplant recipients.
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