Clinical strategies for the management of cytomegalovirus infection and disease in allogeneic bone marrow transplant.

Four clinical strategies are proposed for the management of CMV disease: prophylaxis, suppression, pre-emptive therapy and treatment. The degree of risk of developing CMV disease and the safety profile of the presently available drugs need to be considered when deciding on the most appropriate approach. We conclude that a prophylactic strategy employing a drug with a safe toxicity profile followed by pre-emptive treatment with an effective antiviral drug for failure of prophylaxis gives the best outcome in allogeneic HLA matched bone marrow transplant recipients.