Expert consensus on the management of cytomegalovirus infection in pediatric allogeneic hematopoietic stem cell transplantation

IF 3 4区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Current Research in Translational Medicine Pub Date : 2025-08-15 DOI:10.1016/j.retram.2025.103535

Simone Cesaro , Manuela Spadea , Franca Fagioli , Fulvio Porta , Marco Rabusin , Giulia Ferrando , Adriana Balduzzi , Arcangelo Prete , Marco Zecca , Maura Faraci

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Abstract

Cytomegalovirus (CMV) infection is the most frequent viral complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the pediatric setting, several issues on its management are still debated due to the limited evidence compared to adults. The aim of this consensus was to promote harmonization of practices to improve prevention, control and treatment of CMV infection in children and adolescents.

Consensus was generated through voting by a panel of experts from 8 Italian pediatric transplant units who selected 11 topics on prevention of CMV infection and disease, risk factors, diagnosis, prophylaxis, pre-emptive, and therapeutic approaches and formulated 11 statements.

Statements were generated on impact of CMV infection on allo-HSCT outcome; risk factors for infection; monitoring of patients at risk; duration of infection risk; CMV prophylaxis and CMV pre-emptive strategies; choice of the antiviral therapy; use of CMV-IgG; antiviral combination therapy; role of adoptive cell therapy; therapeutic drug monitoring. All statements reached a mean score of ≥7 (agreement) at the first voting round and reached an even higher level of consensus at the second voting round after discussion and possible modification of some statements.

In conclusion, CMV infection is a risk factor for lower survival and higher non-relapse mortality. We propose a set of expert consensus-generated recommendations aimed at harmonizing the management of CMV infection in pediatric allo-HSCT. We recognize that this field has several unmet needs and emphasize the need for further specific clinical investigations.

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专家对小儿异基因造血干细胞移植中巨细胞病毒感染处理的共识

巨细胞病毒（CMV）感染是同种异体造血干细胞移植后最常见的病毒并发症。在儿科环境中，由于与成人相比证据有限，有关其管理的几个问题仍存在争议。达成这一共识的目的是促进统一做法，以改善儿童和青少年巨细胞病毒感染的预防、控制和治疗。来自意大利8个儿科移植单位的专家小组通过投票达成共识，他们选择了11个主题，包括巨细胞病毒感染和疾病的预防、危险因素、诊断、预防、预防和治疗方法，并制定了11项声明。生成了关于巨细胞病毒感染对同种异体造血干细胞移植结果影响的声明；感染的危险因素；监测高危患者；感染风险持续时间；巨细胞病毒预防和巨细胞病毒预防策略；抗病毒治疗的选择；CMV-IgG的使用；抗病毒联合治疗；过继细胞治疗的作用；治疗药物监测。在第一轮投票中，所有陈述的平均得分均达到≥7分（一致），在第二轮投票中，经过讨论和可能修改的部分陈述，达成了更高的共识。总之，巨细胞病毒感染是低生存率和高非复发死亡率的危险因素。我们提出了一套专家共识生成的建议，旨在协调儿童同种异体造血干细胞移植中巨细胞病毒感染的管理。我们认识到这一领域有几个未满足的需求，并强调需要进一步的具体临床研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Research in Translational Medicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

7.00

自引率

4.90%

发文量

审稿时长

45 days

期刊介绍： Current Research in Translational Medicine is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of hematology, immunology, infectiology, hematopoietic cell transplantation, and cellular and gene therapy. The journal considers for publication English-language editorials, original articles, reviews, and short reports including case-reports. Contributions are intended to draw attention to experimental medicine and translational research. Current Research in Translational Medicine periodically publishes thematic issues and is indexed in all major international databases (2017 Impact Factor is 1.9). Core areas covered in Current Research in Translational Medicine are: Hematology, Immunology, Infectiology, Hematopoietic, Cell Transplantation, Cellular and Gene Therapy.