PRACTICES FOR CYTOMEGALOVIRUS DIAGNOSIS, PROPHYLAXIS AND TREATMENT INALLOGENEIC BONE-MARROW TRANSPLANT RECIPIENTS - A REPORT FROM THE WORKING PARTY FOR INFECTIOUS-DISEASES OF THE EBMT

During the past few years major progress has been made in the diagnosi s and therapy of CMV infection after allogeneic BMT. The aim of this s urvey was to investigate the use of diagnostic techniques, use of prop hylaxis and the therapeutic strategies among members of the EBMT. Seve nty centers from 20 countries responded to the survey. Sixty-seven cen ters (96%) routinely tried to diagnose CMV from the blood. Fifty-seven centers used standard or rapid isolation techniques. Thirty-seven cen ters used one of the newly developed techniques, antigenemia detection in leukocytes or PCR together with isolation, while 10 centers used o ne of these two techniques without standard isolation. Fifty-five cent ers regularly performed bronchoscopy and bronchoalveolar lavage on the suspicion of CMV pneumonia but only 12 centers required detection of CMV in specimens from the lavage or lungs as the indication to start t herapy, 31 centers started therapy on symptoms of pneumonia combined w ith CMV detection from any site. Prophylaxis was used in 54 centers (8 4%). The most commonly used regimen was high-dose acyclovir which was used by 42 centers, while seven centers used ganciclovir. The strategy of early therapy was used by 53 centers (76%) and was most frequently based on detection of viremia or CMV antigen in the blood. CMV pneumo nia was treated by a combination of ganciclovir and iv immunoglobulin by 64 centers, by foscarnet and immunoglobulin in 5 centers and by gan ciclovir alone in 5 centers. CMV gastrointestinal disease was treated by antiviral therapy alone in 18 centers and by a combination of antiv iral therapy and iv immunoglobulin in 46 centers. We conclude that the new approaches to CMV diagnosis and therapy are widely used in Europe ; major differences exist in the diagnostic criteria for CMV disease a nd in the criteria for initiating therapy.