Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea

Cho, Sung-Yeon; Lee, Hyeon-Jeong; Lee, Dong-Gun

Management of CMV is categorized into prevention, pre-emptive treatment, and definitive treatment. Pre-emptive therapy is anti-CMV treatment even in the absence of clinical symptoms in cases with CMV infection (reinfection or reactivation). Most transplantation centers introduce pre-emptive therapy rather than routine universal prevention because of insurance coverage, cost-benefit ratio, and adverse drug reactions. Studies of monitoring strategies and early detection have resulted in the use of CMV pp65 antigenemia testing and real-time qPCR for the surveillance and identification of patients suitable for pre-emptive therapy [82, 83] . However, in HSCT, the relationship between CMV viral load and CMV disease is different from that in solid organ transplantation. CMV gastrointestinal disease can develop without preceding CMV antigenemia or DNAemia, while > 75,000 copies/mL of CMV DNAemia is reportedly associated with an increased risk of CMV retinitis after HSCT [78, 84] . However, the correlations were moderate, and antigenemia or DNAemia does not necessarily precede or accompany CMV disease. Therefore, it is important to identify the at-risk groups and clinical features of the various CMV diseases to facilitate early diagnosis and treatment.