Cytomegalovirus Management in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Cytomegalovirus (CMV) continues to be a major complication in allogeneic hematopoietic cell transplant (aHCT) recipients. Either of two approaches may be used to mitigate the development of CMV after aHCT: preemptive initiation of antiviral treatment upon evidence of viral replication or a primary prophylaxis strategy. Both methods are equally effective, and the strategy employed is based on the patient's specific risks for CMV disease. Given the drugs presently available, both preemptive and prophylactic strategies have shortcomings in terms of toxicity, drug interactions, or costs. The pharmacist has an important role in the selection, dosing, monitoring, and management of CMV therapies in aHCT recipients.