title: Survey of CMV management in pediatric allogeneic HSCT programs, on behalf of the inborn errors, infectious diseases and pediatric diseases working parties of EBMT.
abstract: Human CMV infection is a frequent complication after HSC in children with remarkable morbidity and mortality. Antiviral drugs are relatively efficient but have numerous side effects. They are used as prophylactic, pre-emptive or therapeutic medicines. It is still a matter of debate which option is the best strategy. No uniform procedure has emerged regarding these three options, and new immunologic tools have raised more questions for physicians. To assess the current practice in the management of CMV infection, we sent a questionnaire to the EBMT centers performing hematopoietic SCT (HSCT) in children. Fifty-six out of 196 responded to the questionnaire (28.5%). Quantitative PCR was the most common monitoring tool (44/56). Only 4/56 centers use the pp65 antigenemia alone. All centers used pre-emptive strategy (56/56). 21/56 centers also used prophylactic measures, 13/21 after analysis of donor/receptor serologic status. Ganciclovir was the most common first-line agent for CMV disease (55/56). The most common dose and duration for induction treatment were 5 mg/kg bid (47/55) for 14 days (20/55). There is no uniform procedure for researching resistance strain, antiviral second-line therapy or cell therapy. A harmonization process should enable sound prospective trials to improve prevention, control and cure of CMV disease in children and adolescents.
authors.affiliation: Department of Hematology and Immunology, Hospital Robert Debre, Paris 7-Paris Diderot University, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Bontant
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Sedlaçek
authors.affiliation: Clinica Pediatrica Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza (Milano), Italy.
authors.forename: A
authors.initials: A
authors.lastname: Balduzzi
authors.affiliation: Chair of EBMT Inborn Error Working Party, Molecular Immunology Unit, UCL Institute of Child Health, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Gaspar
authors.affiliation: Chair of EBMT Infectious Disease Working Party, Paediatric Haematology Oncology Policlinico G.B. Rossi, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cesaro
authors.affiliation: Division of Hematology, Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Einsele
authors.affiliation: Chair of EBMT Paediatric Diseases Working Party, St Anna Children's Hospital, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.affiliation: Department of Hematology and Immunology, Hospital Robert Debre, Paris 7-Paris Diderot University, Paris, France.
authors.forename: J-H
authors.initials: JH
authors.lastname: Dalle
mesh_terms: D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011795:Surveys and Questionnaires; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*