Cytomegalovirus reactivation prevention and treatment post-hematopoietic stem cell transplantation: a Delphi study in four Gulf cooperation council countries

BACKGROUND: These Delphi recommendations aimed to establish regional consensus for the effective management of Cytomegalovirus (CMV) reactivation/infection and CMV disease following allogeneic hematopoietic stem cell transplantation (alloHSCT). METHOD: A modified Delphi approach, comprising three rounds of anonymous questionnaires with field experts, was used. The first round included open-ended questions to identify and prioritize key topics, while the subsequent rounds focused on refining responses and reaching a consensus. A predefined consensus threshold of 70% agreement among panelists was used. RESULTS: After two rounds, a consensus was reached on 21 key questions related to the diagnosis and management of CMV reactivation and CMV disease post-alloHSCT. The panel identified these areas as priorities for future research or guideline refinement. CONCLUSION: This Delphi study successfully established an expert consensus on pre-emptive therapy and prophylactic treatment for managing CMV reactivation and treatment strategies for CMV disease. The study findings, based on inputs from experts related to clinical practices in the region, can serve as an additional tool for clinical decision-making. Moreover, the panelists highlighted the unmet need for harmonizing diagnostic practices and thresholds among hematology centers in the Gulf region. CLINICAL TRIAL NUMBER: Not applicable.