A survey of allogeneic bone marrow transplant programs in the United States regarding cytomegalovirus prophylaxis and pre-emptive therapy

Despite an extensive literature, no consensus has emerged regarding the opt imal preventive strategy for CMV in allogeneic bone marrow transplantation (BMT), No survey of CMV prevention in BMT centers in the United States has yet been published. A questionnaire was sent to all allogeneic BMT programs in the United States, as listed in the November 1998 National Marrow Donor Program (NMDP) address roster. Questions included whether universal prophy laxis, preemptive therapy, or some other strategy was used for CMV preventi on, and which CMV diagnostic tests were utilized. Eighty-one of 96 programs (86%) responded to the survey. Of these, 46 (56%) utilize a pre-emptive ga nciclovir strategy, whereas 17 (21%) utilize universal prophylaxis, and 15 (19%) utilize a hybrid strategy based on risk stratification, The most comm only utilized CMV diagnostic tests are CMV-DNA by PCR (55 centers), shell v ial centrifugation culture (52), tissue culture (42), pp65 antigenemia assa y (38), and CMV-DNA by Digene hybrid capture (14), Of these, the CMV-DNA by PCR, pp65 antigenemia assay, and shell vial culture are the most frequentl y utilized as triggers for preemptive therapy. Quantitative assays are comm on (PCR 42%, Digene 64%), We conclude that centers currently performing all ogeneic BMT in the United States employ a variety of strategies for CMV pre vention, and differ in their diagnostic tests of choice for CMV monitoring. These results emphasize the need for large-scale studies to identify optim al diagnostic and management protocols.