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Canadian Journal of Infectious Diseases
Volume 10, Issue 6, Pages 410-414
http://dx.doi.org/10.1155/1999/480541
Original Article

A Cross-Canada Survey of Cytomegalovirus Prevention and Treatment Practices in Bone Marrow Transplant Recipients

Atul Humar,1,3 Jeff Lipton,2,3 Hans Messner,2,5 Allison McGeer,5 and Tony Mazzulli5

1Department of Medicine, Division of Infectious Diseases, The Toronto Hospital, Toronto, Ontario, Canada
2Department of Medical Oncology and Hematology, University of Toronto, Toronto, Ontario, Canada
3University of Toronto, Toronto, Ontario, Canada
4Allogenic Bone Marrow Transplant Program, Princess Margaret Hospital, Toronto, Ontario, Canada
5Allogenic Bone Marrow Transplant Program, University Network, University of Toronto; Department of Pathobiology and Laboratory Medicince, Medicine and Public Health Sciences, University of Toronto; Department of Laboratory Medicine and Pathobiology, University of Toronto; Department of Microbiology, Mount Sinai and Princess Margaret Hospital, Toronto, Ontario, Canada

Received 28 October 1998; Accepted 2 February 1999

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

OBJECTIVE: To gather information about cytomegalovirus (CMV) prevention and treatment practices in bone marrow transplantation (BMT) in Canada.

DESIGN: A questionnaire was mailed to all centres across Canada performing BMT in January 1998. A second mailing was sent three months later.

POPULATION STUDIED: Data on 15 centres performing allogeneic BMT (total patients 459) and 16 centres (total patients 703) performing autologous BMT were obtained.

RESULTS: For allogeneic BMT, all donors and recipients had pretransplant CMV serology performed. Nine centres gave CMV-negative blood to only donor-negative/recipient-negative patients, four centres to all patients and two centres to other subgroups. All allogeneic BMT centres had a strategy for CMV prevention. Three centres used universal ganciclovir prophylaxis, while 12 centres used some form of pre-emptive ganciclovir therapy based on weekly antigenemia assays (four centres), weekly polymerase chain reaction (two centres), CMV blood cultures (one centre), CMV throat and urine cultures (one centre), CMV screening bronchoscopy (two centres), or a combination of antigenemia plus bronchoscopy (two centres). The dose and duration of pre-emptive ganciclovir varied considerably from centre to centre. In addition, many centres used high dose acyclovir universally for a variable period of time post-BMT. For the treatment of CMV pneumonia, 14 centres used ganciclovir plus immunoglobulin (IG) and one centre used ganciclovir alone. Ganciclovir treatment duration ranged from two to 11 weeks and the number of doses of IG from three to 18. Thirteen of 16 autologous BMT centres screened patients for CMV pretransplant. Ten centres used CMV negative blood for some or all of their patients. Only one centre performed routine CMV monitoring after autologous BMT.

CONCLUSIONS: Practices for the prevention of CMV disease in BMT patients differ widely across centres, and further data may assist in developing a consensus regarding the optimal approach to CMV management.