Table 1.
Key Differences Between Prophylaxis Versus Preemptive Therapy for Cytomegalovirus Prevention Among Solid Organ Versus Hematopoietic Cell Transplant Recipients
| Transplant Type | Solid Organ Transplantation | Hematopoietic Cell Transplantation | ||
|---|---|---|---|---|
| Prophylaxis | Preemptive | Prophylaxis | Preemptive | |
| Clinical practice | Commonplace | Uncommon | Uncommon | Commonplace |
| Positives | Large evidence base Ease of coordination Prevents CMV infection/disease and indirect effects of CMV (graft loss, opportunistic infections) | Simulates natural CMV immunity Prevents delayed-onset CMV Less neutropenia Possibly more cost-effective | Reduction in mortality among CMV-seropositive recipients | Large evidence base Limited toxicity Acceleration of immune constitution Possible protective effect on leukemia relapse |
| Negatives | Postprophylaxis disease High cost Neutropenia Use of antivirals in some patients who will not develop CMV infection | Logistical difficulties Small evidence base Unknown impact on indirect effects of CMV Viral thresholds not defined Unknown frequency of testing Rapid doubling time of CMV viral loads in some patients | Exacerbation of cytopenias with ganciclovir/valganciclovir Poor efficacy of acyclovir/valacyclovir Low bioavailability of oral antivirals in persons with GVHD Use of antivirals in some patients who will not develop CMV infection | Logistical difficulties Rapid doubling time of CMV viral loads in some patients |
Abbreviations: CMV, cytomegalovirus; GVHD, graft-vs-host disease.