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 CoveredFundamentals of CMV ManagementDistinguishing CMV reactivation from CMV diseaseTreatment thresholds and target viral loadsProphylaxis strategies in non-allograft settingsValaciclovir dosing in general hematology populationsHigh-risk patient populationsFirst-Line TherapiesValganciclovir: advantages, disadvantages, and myelosuppressionFoscarnet: indications and monitoring strategiesTreatment-resistant CMVAllogeneic Transplant PatientsHigh-risk populations and timing of reactivationMonitoring protocols post-transplantRandomized Controlled TrialsAURORA Trial: Maribavir vs. ValganciclovirDesign: RCT comparing maribavir to valganciclovir for pre-emptive CMV therapy post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/38036487/]NEJM Letermovir Prophylaxis TrialDesign: Double-blind, placebo-controlled RCT of letermovir prophylaxis post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/29211658/]Emerging Patient PopulationsCMV in lymphoma and myeloma patients receiving CAR T-cell therapy and T-cell engaging bispecific antibodiesMonitoring and prophylaxis strategies for novel immunotherapiesImpact of CMV on post-CAR T mortality-https://pubmed.ncbi.nlm.nih.gov/40203190/