Co-Chairs, Roy F. Chemaly, MD, MPH, FIDSA, FACP, and Genovefa Papanicolaou, MD, FIDSA, Fellow ASCT, prepared useful Practice Aids pertaining to cytomegalovirus for this CME/NCPD activity titled “Cracking Down on Post-Transplant CMV: Guidance on Sequential Treatment With Newer Antiviral Agents.” For the full presentation, downloadable Practice Aids, and complete CME/NCPD information, and to apply for credit, please visit us at https://bit.ly/3sNOKh8. CME/NCPD credit will be available until March 25, 2025.

1. CMV Practice Principles: Identification, Risk
Factors, and Treatment Recommendations
Full abbreviations, accreditation, and disclosure information available at
PeerView.com/WAV40
a
CMV viral load at the same level or higher than the peak viral load within 1 week but <1 log10 increase in CMV DNA titers done in the same laboratory and with the same assay.
1. Khawaja F et al. Clin Microbiol Infect. 2023;29:44-50. 2. Yong MK et al. Transplant Cell Ther. 2021;27:957-967.
3. Livtencity (maribavir) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215596lbl.pdf.
R/R CMV Risk Factors
R/R CMV Definitions
Clinical Note: Antivirals such as foscarnet, ganciclovir, and others are currently
recommended to treat CMV infection in the post-HCT setting2
Clinical Note 2: The antiviral agent maribavir 400 mg is approved for the treatment of
adults and pediatric patients (12 years of age and older and weighing at least 35 kg)
with post-transplant CMV infection/disease that is refractory to treatment (with or
without genotypic resistance) with ganciclovir, valganciclovir, cidofovir, or foscarnet3
Defining Relapsed/Refractory CMV and Review of Risk Factors1
Probable Refractory CMV
Infection
Persistent virusa
after ≥2 wk
of appropriately dosed
antiviral therapy
Refractory CMV Infection
CMV viremia that increases
≥1 log10 in blood or serum
after 2 wk of appropriate
antiviral therapy
Antiviral Drug Resistance
Viral genetic variations of
genes UL97, UL54, UL27,
UL51, UL56, and UL89
that decrease the
susceptibility to one or
more anti-CMV drugs
Prolonged
antiviral
treatment
Previous
antiviral
exposure
Recurrent
infection
Immunosuppressive
therapy
Poor drug
absorption or
drug conversion
Type of
transplant