Pre-emptive antiviral therapy for active CMV infection in adult allo-SCT patients guided by plasma CMV DNAemia quantitation using a real-time PCR assay: Clinical experience at a single center

摘要

Pre-emptive antiviral therapy is the first-choice strategy for the prevention of CMV end-organ disease in the allo-SCT setting.1 In recent years, most institutions, including ours, have switched from the pp65 antigenemia assay (AG) to quantitative real-time PCR methods (QRT-PCR) for the guidance of pre-emptive antiviral therapy. Nevertheless, there are scarce published data as to how both strategies compare in terms of their clinical efficacy. Although the criteria for initiation and cessation of pre-emptive antiviral therapy guided by the AG assay are rather standard across transplantation centers, there are no consensus criteria as to how active CMV infection should be managed in the QRT-PCR era.1 In fact, no validated CMV DNA load threshold (in either whole blood or plasma) exists for the inception of antiviral therapy, nor has a consensus been reached as to when antiviral treatment should be stopped (first negative QRT-PCR result/second negative QRT-PCR result/decrease of CMV DNA load below the cutoff for initiation of pre-emptive antiviral therapy).