Hematology

Per Ljungman, MD, on the Guidelines on Managing CMV in Patients Taking Hematological Therapies

The 2017 European Conference on Infections in Leukemia (ECIL 7) has updated its recommendations for diagnosing and managing cytomegalovirus (CMV) in patients who have had hematopoietic stem cell transplantation and in patients receiving other types of therapy for hematological malignancies.1

Lead author of the guidelines and chair of the ECIL 7, Per Ljungman, MD, answered our questions about the updates.

Per Ljungman, MD, is professor emeritus at the Karolinska Institute and senior consultant in the Department of Cellular Therapy and Allogeneic Stem Cell Transplantation at Karolinska University Hospital in Stockholm, Sweden.

INFECTIOUS DISEASES CONSULTANT: Can you give us an overview of the new guidelines?

Per Ljungman: The guidelines are an update of our previous guidelines from 2011. A lot has happened during this intervening period regarding our knowledge about CMV. The most important is the availability of a new effective antiviral drug for prophylaxis, letermovir. This has completely changed the strategy for management of allogeneic stem cell transplant recipients. The guidelines also summarize the knowledge regarding the importance of CMV in non-transplant patients with hematologic malignancies.

ID CON: How has the diagnosis, prevention, and management of CMV infection changed over the years?

PL: For the last decade, preemptive therapy based on detection of CMV in blood by sensitive and quantitative diagnostic techniques has been the standard in managing allogeneic stem cell transplant recipients. This technology has been fine-tuned and standardized during this period with the introduction of the so-called “World Health Organization standard.” The successful phase III study of letermovir as prophylaxis against clinically significant CMV infection in seropositive allogeneic hematopoietic stem cell transplant recipients has changed the situation in a very positive manner so that now antiviral prophylaxis is an effective preventive strategy. However, it must be combined with monitoring and preemptive therapy, especially after discontinuation of the prophylaxis.

ID CON: Why are these guidelines important, and why update them now?

PL: The purpose of the ECIL 7 is to develop and update guidelines when new developments change the field. It has now been several years since we have updated our CMV management guidelines, and with the new developments, it was time to do it now.

ID CON: What is the key take-home message for health care providers?

PL: That antiviral prophylaxis with letermovir used as approved by the US Food and Drug Administration2 is now a recommended strategy in CMV seropositive allogeneic hematopoietic stem cell transplant recipients.

Reference:

  1. Ljungman P, de la Camara R, Robin C, et al; 2017 European Conference on Infections in Leukaemia group. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19(8):e260-e272. https://doi.org/10.1016/S1473-3099(19)30107-0.
  2. Drug Trial Snapshots: PREVYMIS. US Food and Drug Administration. Updated December 1, 2017. Accessed September 4, 2019. https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-prevymis.