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Improved surveillance, prophylaxis suggested for CMV in pediatric bone marrow transplantation
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Improved surveillance and pre-emptive therapies may be required to better manage late-onset cytomegalovirus infections among pediatric bone marrow transplant patients.
“Among allogeneic and autologous blood and marrow transplant recipients, infectious mortality accounts for 20% and 8% of all cases, respectively,” Hisham Abdel-Azim, MD, of the Children’s Hospital Los Angeles and the University of Southern California, and colleagues wrote. “There have been recent calls to develop new strategies to overcome the limitations of current antimicrobial regimens, particularly as this relates to viral complications following bone marrow transplant.”
To assess clinical practice patterns regarding infectious diseases among accredited pediatric bone marrow transplant centers, and the extent to which infection prevention guidelines have been implemented, researchers conducted an anonymous email survey of 64 bone marrow transplant center program directors. Selected program directors were asked to identify their clinical practices by choosing among listed options.
The researchers categorized the responses as complete and partial, with complete responses defined as 80% or more of questions answered. A partial response was defined as more than 50% and less than 100% of questions answered. The overall response rate was 56% with 24 complete responses and 12 partial responses.
Reported clinical practices were similar in terms of intravenous globulin administration, treatment of viral complications and environmental precautions.
However, researchers observed variations in clinical practice regarding the surveillance of late-onset cytomegalovirus (CMV) surveillance, with less than 50% reporting screening transplant recipients for CMV more than 100 days after transplant in cases of low CD4 count, seropositive recipients with a seronegative donor, recipients of unrelated, haploidentical or T-cell depleted grafts and recipients of umbilical cord blood grafts.
“A recent survey of CMV management among pediatric bone marrow transplantation programs, support our own finding that further attention to late-onset CMV surveillance strategies may be indicated,” Abdel-Azim and colleagues wrote. “Confusion regarding best practice for appropriate CMV surveillance strategies and whether pre-emptive therapy is associated with late-onset CMV disease, suggest that prospective studies are needed to promote a more harmonized management approach.”
Seventy percent of respondents (CI, 49%-84%) reported the use of voriconazole for antifungal prevention for transplant patients with a suspected or confirmed history of aspergillosis. Despite this practice, 56% (CI, 33%-77%) did not report therapeutic drug monitoring for the prophylactic use of voriconazole.
“Prospective studies are needed to address variability in screening for late onset CMV and to harmonize best practice,” the researchers wrote. “Variability in therapeutic drug monitoring of antimicrobials should be addressed.”
Disclosure: The researchers report no relevant financial disclosures.
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