Pre-emptive approach against toxoplasmosis in allogeneic haematopoietic cell transplantation. Still far away from experience in CMV

Abstract

Reactivation of toxoplasmosis after allogeneic haematopoietic cell transplantation (allo-HCT) is still an issue of concern [1]. Prophylaxis with cotrimoxazole is generally the mainstay preventive measure in high-risk patients, and also includes Pneumocystis jirovecii, although its use is generally limited by the risk of potential toxicity to grafted cells and delayed engraftment [2]. Molecular techniques for Toxoplasma detection in blood samples, initially used for the early diagnosis of disseminated toxoplasmosis [3,4], are being postulated as potential monitoring tools for pre-emptive strategies in this population, since blood DNAaemia can precede end-organ toxoplasmosis by weeks [5], and monitoring of toxoplasma DNAaemia has been recommended in high-risk allo-HCT recipients not receiving toxoplasma prophylaxis in the early post-allo-HCT period [6,7].