Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.287
Peer-review started: June 5, 2015
First decision: August 10, 2015
Revised: October 17, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: December 24, 2015
Cytomegalovirus (CMV) infection is an important contributor to the morbidity and mortality associated with bone marrow transplantation (BMT). Infection may lead to CMV disease involving multiple organs such as pneumonia, gastroenteritis, retinitis, central nervus system involvement and others. CMV seropositivity is an important risk factor and approximately half of BMT recipients will develop clinically significant infection most commonly in the first 100 d post-transplant. The commonly used tests to diagnose CMV infection in these patients include the pp65 antigenemia test and the CMV DNA polymerase chain reaction (PCR) assay. Because of its greater sensitivity and lesser turnaround time, the CMV PCR is nowadays the preferred test and serves as a main guide for pre-emptive therapy. Methods of CMV prevention include use of blood products from seronegative donors or leukodepleted products. Prophylaxis or pre-emptive therapy strategies for CMV prevention may be used post-transplant with the latter becoming more common. The commonly used antivirals for pre-emptive therapy and CMV disease management include intravenous gancyclovir and foscarnet. The role of intravenous immunoglobulin, although used commonly in CMV pneumonia is not clear.
Core tip: Cytomegalovirus (CMV) infection and CMV disease may be associated with serious complications in the bone marrow transplant patient. The most commonly used test to monitor CMV replication is the CMV DNA polymerase chain reaction assay and serves a guide for preemptive therapy. Gancyclovir followed by foscarnet are most commonly used in CMV management.