Would monitoring CMV immune responses allow improved control of CMV in stem cell transplant patients

Background: Virological monitoring with sensitive assays and subsequent introduction of antiviral preemptive therapy has become a routine strategy in the management of stem cell transplant recipients. Several techniques have been used and each has advantages and disadvantages. Objective: The objective of this review is to discuss the drawbacks of virological monitoring alone for the management of CMV in stem cell transplant recipients. Study design: Publications on the success of CMV viral load monitoring were reviewed with special emphasis on the timing of CMV disease after stem cell transplantation. Results and conclusions: During recent years CMV disease has more frequently been documented later after transplantation and has been associated with the absence of CMV-specific immune responses. Repeated antiviral therapy carries the risk of toxicity and the development of resistance. Hence virological monitoring might be insufficient for optimal management of these patients. This realization has spurred interest in evaluating assays for immunological monitoring as a means of improving control of potential CMV disease after transplantation. (C) 2005 Elsevier B.V. All rights reserved.