How to manage cytomegalovirus reactivation/infection after hematopoietic stem cell transplantation: practical tips for clinicians

Abstract

Cytomegalovirus (CMV) reactivation is one of the most common and life-threatening complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is associated with an increased risk of transplantation failure, non-relapse mortality (NRM), and lower overall survival (OS) than in patients without CMV reactivation, even in the era of pre-emptive antiviral treatment. Numerous risk factors for CMV reactivation in the setting of allo-HSCT have been identified. Donor/recipient CMV serological status remains the main risk factor influencing the incidence and mortality of CMV disease after transplantation. Proper selection of donor and recipient, regular and careful monitoring, an early intervention in CMV reactivation, and rapid and effective treatment when the disease develops, remain crucial to decrease the risk of post-transplantation CMV reactivation/disease. The introduction of letermovir as CMV prophylaxis has reduced NRM and improved OS. Herein we present practical tips as to how to manage CMV reactivation/disease after allo-HSCT through an illustrative case report, with a focus on the risk factors present before and during the procedure.