Episode 67. Management of CMV in Hematologic Malignancies

Join hosts Eddie, Ashwin, and Raj as they welcome Dr. Michelle Yong and Dr. Gemma Reynolds, academic infectious diseases physicians from the Peter MacCallum Cancer Centre and the National Centre for Infections in Cancer, for an in-depth discussion on cytomegalovirus (CMV) management in immunocompromised hematology patients.

Key Topics Covered

Fundamentals of CMV Management

• Distinguishing CMV reactivation from CMV disease
• Treatment thresholds and target viral loads
• Prophylaxis strategies in non-allograft settings
• Valaciclovir dosing in general hematology populations
• High-risk patient populations

First-Line Therapies

• Valganciclovir: advantages, disadvantages, and myelosuppression
• Foscarnet: indications and monitoring strategies
• Treatment-resistant CMV

Allogeneic Transplant Patients

• High-risk populations and timing of reactivation
• Monitoring protocols post-transplant

Randomized Controlled Trials

AURORA Trial: Maribavir vs. Valganciclovir

• Design: RCT comparing maribavir to valganciclovir for pre-emptive CMV therapy post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/38036487/]

NEJM Letermovir Prophylaxis Trial

• Design: Double-blind, placebo-controlled RCT of letermovir prophylaxis post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/29211658/]

Emerging Patient Populations

• CMV in lymphoma and myeloma patients receiving CAR T-cell therapy and T-cell engaging bispecific antibodies
• Monitoring and prophylaxis strategies for novel immunotherapies
• Impact of CMV on post-CAR T mortality-https://pubmed.ncbi.nlm.nih.gov/40203190/