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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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.