Overview
Establishing Multidisciplinary Frameworks for CMV Prevention and Treatment in High-Risk Posttransplant Patients
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Cytomegalovirus (CMV) is an opportunistic pathogen in both solid organ and hematopoietic stem cell transplant (HSCT) settings, and breakthrough infections and development of refractory and resistant infections cause significant complications posttransplant. To lessen patient burden and improve survival outcomes, optimal introduction of anti-CMV drugs for both prophylaxis and treatment is critical. To address these needs, multidisciplinary clinical teams must implement the latest advances in CMV monitoring, prevention, and treatment in patients with and without antiviral drug resistance. This interactive practice guide interweaves education and practical guidance for easy integration of the latest evidence into routine clinical practices, processes, and workflows.
This educational activity is designed for US-based healthcare providers who care for patients with or at risk for CMV infection, including solid organ and hematopoietic stem cell transplant specialists/surgeons, hematologists/oncologists, nephrologists, infectious disease specialists, transplant pharmacists, internal medicine and primary care physicians, nurses, and advanced practice providers (NPs/PAs).
Cytomegalovirus (CMV) infection is a serious complication with implications for morbidity and mortality in patients who have recently undergone solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT). Posttransplant CMV can cause tissue-invasive disease, including pneumonia, hepatitis, gastroenteritis, retinitis, and encephalitis, which can develop at various times (early and late) after the procedure. Patients who develop a CMV infection ≥100 days after transplantation have been shown to have a 4.8-fold increased risk of death compared with those who do not develop late CMV. In addition, for some patients, CMV becomes resistant or refractory to treatment, leading to prolonged therapy. Advancements in prophylaxis and treatment have the potential to greatly improve outcomes but require patient monitoring and optimal treatment selection. This education program, developed for multidisciplinary teams, will provide clinicians involved in the management of transplant patients with targeted interventions to address knowledge and competency gaps in CMV infection risks, prevention, and treatment.
Upon completion of this activity, learners will be able to:
• Identify patients at high risk for CMV infection following a solid organ or hematopoietic stem cell transplant
• Describe potential consequences and risk posed by CMV infection in posttransplant patients
• Create effective prophylaxis regimens for patients at risk for CMV infection posttransplant
• Individualize treatment plans for posttransplant patients with refractory/resistant CMV infection
• Identify patients at high risk for CMV infection following a solid organ or hematopoietic stem cell transplant
• Describe potential consequences and risk posed by CMV infection in posttransplant patients
• Create effective prophylaxis regimens for patients at risk for CMV infection posttransplant
• Individualize treatment plans for posttransplant patients with refractory/resistant CMV infection
CMV infection in posttransplant patients, risk factors, and outcomes
Prophylaxis vs preemptive therapy (PET)
Treatment strategies for CMV disease and R/R CMV
Improving coordination of care through clinical pathways and multidisciplinary strategies
This educational activity is presented in collaboration with Rush University Medical Center and the Academy for Continued Healthcare Learning (ACHL).
Supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc.
1. Active Internet connection (DSL or Cable). Dial-up connection will have constant buffering problem.
2. Compatible with Windows PC and MAC (256 MB of RAM or higher)
3. Activity is best viewed on Internet Explorer 9.0 or higher, Safari 5.0 or higher and Firefox 29.0 or higher
4. Adobe Flash Player 12.0 (or higher). Click here to download Adobe Flash Player for free.
5. Adobe Reader to print certificate. Click here to download Adobe Reader for free.
6. Allow ActiveX controls to run on your computer: If the yellow strip appears on the top of your web browser while running the Webcast, right click on it and select Allow blocked contents to run.
7. Turn the Pop-up blocker off: On the Tools menu, point to Pop-up Blocker, and then click Turn Off Pop-up Blocker
2. Compatible with Windows PC and MAC (256 MB of RAM or higher)
3. Activity is best viewed on Internet Explorer 9.0 or higher, Safari 5.0 or higher and Firefox 29.0 or higher
4. Adobe Flash Player 12.0 (or higher). Click here to download Adobe Flash Player for free.
5. Adobe Reader to print certificate. Click here to download Adobe Reader for free.
6. Allow ActiveX controls to run on your computer: If the yellow strip appears on the top of your web browser while running the Webcast, right click on it and select Allow blocked contents to run.
7. Turn the Pop-up blocker off: On the Tools menu, point to Pop-up Blocker, and then click Turn Off Pop-up Blocker
Fernanda P. Silveira, MD, MS, FIDSA, FAST
Professor of Medicine
Transplant Infectious Diseases Physician
Clinical Operations Director, Transplant Infectious Diseases
Division of Infectious Diseases
University of Pittsburgh and UPMC
Pittsburgh, PA
Professor of Medicine
Transplant Infectious Diseases Physician
Clinical Operations Director, Transplant Infectious Diseases
Division of Infectious Diseases
University of Pittsburgh and UPMC
Pittsburgh, PA
Roy F Chemaly, MD, MPH, FIDSA, FACP
Professor and Chair
G. P. Bodey, Sr. Distinguished Professorship in Infectious Diseases
Director, Clinical Virology Research
Department of Infectious Diseases, Infection Control, and Employee Health
University of Texas MD Anderson Cancer Center
Houston, TX
It is the policy of the Interprofessional Continuing Education office at RUSH to ensure that its CE activities are independent, free of commercial bias. Therefore, we manage all financial relationships associated with accredited continuing education activities. RUSH asks everyone who has the ability to control or influence the content of an educational activity to disclose information about all of their financial relationships with ineligible companies within the prior 24 months. An ineligible company is an entity whose primary business is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients. There is no minimum threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. Individuals must disclose regardless of their view of the relevance of relationships to education. Mechanisms are in place to identify and mitigate any potential conflicts of interest prior to the planning, implementation, or evaluation of the continuing education activity. If a financial relationship is identified for the person in control of content, conflict mitigation strategies will be used to mitigate the financial relationship before they assume their role.
Individuals in control of content for this activity have the following relevant financial relationships with ineligible companies to disclose and all financial relationships have been mitigated.
Fernanda P. Silveira, MD, MS
Sources of Funding for Research/Grants: Ansun Biopharma, Inc., Glaxo Smith Kline, Merck & Co. Inc., Regeneron Pharmaceuticals, Inc., SlieaGen, LLC.
Advisory Board Member: Eurofins Viracor
Roy F Chemaly, MD, MPH, FIDSA, FACP
Advisor: ADMA Biologics, Inc., Assembly Biosciences, Inc., Gilead Sciences, IntegerBio, Invivyd, Karius, Moderna, Pfizer, Tether Therapeutics
Sources of Funding for Research/Grants: AiCuris, Ansun Biopharma, Eurofins Viracor, LLC, FreeStyle, Genetech, Karius, Merck, Takeda
Consulting Agreements: Ansun Biopharma, Astellas, Eurofins Viracor, LLC, Merck & Co, Inc., Pulmotec, Shionogi, Inc. Takeda
Stock Options: Xenex
Rush University Medical Center and the Office of Interprofessional Continuing Education staff members, ACHL staff members, and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.
The content for this activity was developed independently of any ineligible company. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantor(s).
This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.
Unapproved Uses of Drugs/Devices: In accordance with requirements of the FDA, the audience is advised that information presented in this continuing medical education activity may contain references to unlabeled or unapproved uses of drugs or devices. Please refer to the FDA approved package insert for each drug/device for full prescribing/utilization information.
Discussion of scientific information on unapproved uses (SIUU), off-label, investigational, or experimental drug/device use: Valganciclovir, foscarnet, and cidofovir are not approved for the treatment of CMV infection/disease in HSCT; letermovir is not approved for the treatment of CMV disease and is not approved for CMV prophylaxis in solid organ transplant except kidney transplant; maribavir is not approved for prophylaxis or initial treatment of CMV infection/disease
This activity will take approximately 90 minutes to complete. To receive credit, learners are required to complete the pretest, view the online activity, and complete the posttest and evaluation. To receive credit, 80% must be achieved on the posttest. A certificate will be immediately available. There is no fee to participate in the activity or for the generation of the certificate.
For questions, contact McKenna Reinhard at mreinhard@achlcme.org or (877) 444-8435 ext. 121.
The CPE credits will be posted in the NABP profile within 30 days of participation
In support of improving patient care, Rush University Medical Center is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
This activity is being presented without bias and with commercial support.
Rush University Medical Center designates this Enduring Material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
Rush University Medical Center designates this Enduring Material for a maximum of 1.5 nursing contact hour(s).
Rush University Medical Center designates this application-based activity for a maximum of 1.5 contact hour(s) for pharmacists. ACPE Universal Activity Number: JA0000275-0000-25-067-H01-P
Completion of this activity, including the pretest, posttest, and follow-up assessments, qualifies as a medium weight MIPS improvement activity under MACRA and can be claimed as completion of IA_PSPA 28 of an Accredited Safety or Quality Improvement Program in the Quality Payment Program. Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website. You will receive additional information after completing the activity and receiving your certificate via email.
