CMV AFTER YOUR STEM CELL TRANSPLANT (HCT)

A Starting Point

When you undergo a stem cell transplant (also known as SCT, hematopoietic cell transplant (HCT)*, hematopoietic stem cell transplant (HSCT), bone marrow transplant (BMT), cord blood transplant (CBT), or peripheral blood stem cell transplant (PBSCT)), you are first given combinations of chemotherapy, radiation therapy, and/or immune suppression (known as conditioning) in order to kill diseased cells, make way for healthy new cells, and suppress your immune system so you don’t reject the donor cells.

*HCT will be the abbreviation used throughout this website for these types of transplants.

A Vulnerable System

Suppressing the immune system, however, also has other effects. It can make you susceptible to infections, including cytomegalovirus (CMV).

After your transplant, there’s a good chance you’ll be feeling weak and ill, but you may also be feeling emotionally stressed and worried. These feelings are normal and understandable. Be sure to talk with your healthcare team about how you are feeling and about your emotions.

What You Can Do

In working through your experience and feelings, it’s helpful sometimes to know what to expect regarding CMV based on where you are in your specific transplant journey.

During the first few weeks after transplant, your immune system will remain suppressed as your new stem cells begin to produce healthy cells.

Also, after you receive your transplant, you will take medicines for a while to suppress the immune system and keep it from attacking your new stem cells.

The CMV Basics

Many people experience an infection with CMV after transplant. If you have had an organ transplant, here is some basic information about CMV that may be helpful.

  • CMV is a common virus and is related to those that cause mononucleosis (often referred to as “mono”) and chicken pox.
  • Most people don’t even realize they have the CMV virus in their body because it rarely causes problems.
  • A healthy immune system keeps it in check.
  • With a healthy immune system, a CMV infection usually goes away by itself without causing much notice.
  • Once you’ve been infected with CMV, however, you always have the virus in your body.
  • It stays there for life, usually remaining quiet or inactive, without causing any problems.
  • If CMV does reactivate, you may experience a flu-like illness with swollen lymph nodes, muscle aches or weakness, fatigue, and fever.
  • Be sure to speak with your healthcare team about how you’re feeling and if you have any of these or other symptoms.
  • If you have an active CMV infection, it can become refractory or resistant to medications currently used to manage it.
  • This means those medications will be less useful over time against CMV.

If your immune system becomes weakened or compromised at some point, however, CMV may reappear and become active again (reactivate).

This can occur in anyone, regardless of whether they have had a transplant.

 

Click the section below based on where you are in your transplant journey to learn more about CMV.

Prior to HCT

You will receive many tests and procedures, including a blood test to see if you have CMV in the body. If you are receiving cells from a donor (allogeneic transplant), your donor will also be tested for CMV.

  • If you do have CMV in the body, there is a chance that the virus may reactivate after your transplant.
  • If you do not have CMV in the body, there is a chance you may become newly infected with it if the donated cells were already carrying the virus. There is also a very small chance that you can be infected by CMV like any other virus.

Knowing whether CMV is present in either you or the donor cells will help your healthcare team evaluate who would be a good donor and later to create a plan to help manage the risk of CMV infection.

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Knowing whether CMV is present in either you or the donor cells will help your healthcare team evaluate who would be a good donor and later to create a plan to help manage the risk of CMV infection.

The Weeks After HCT

A common strategy in HCT is to prevent active CMV infection by using antiviral medicines before an infection can occur (known as preventive treatment or prophylaxis).

Another common strategy transplant teams use to reduce the chance of an active CMV infection after HCT is called preemptive treatment.

Your weakened immune system can leave you at risk of infections like CMV. This is why your transplant team may put you on prophylactic treatment before an infection can occur. You may also be tested frequently to monitor CMV levels in the body and given preemptive treatment if CMV levels start to increase (even if you don’t feel symptoms).

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Post-Transplant and Beyond

Your doctor will keep track of your progress by testing the levels of virus in your blood.

Sometimes, infections might not respond or stop responding to the medicines your doctor prescribed. This is called refractory CMV. If you have refractory CMV, your doctor might do an additional test to see if the CMV virus you are infected with has a gene mutation known to prevent the medicines from working—this is called resistant CMV.

HCT recovery can be long and hard—especially if you have active CMV. It is important to stay in frequent and open communication with your healthcare team throughout the process.

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HCT recovery can be long and hard—especially if you have active CMV. It is important to stay in frequent and open communication with your healthcare team throughout the process.

 

Throughout Your Recovery

You may feel frustrated, especially if your questions are not being understood or answered, but your health is important, so persevere and get the answers you need to feel comfortable.

Download the Talking with Your Transplant Team tool for some examples of questions you might consider asking and tips for managing discussions with your team.