Development of an Iranian National Clinical Practice Guideline for the Prevention, Diagnosis, and Treatment of Cytomegalovirus Infection in Hematopoietic Stem Cell Transplant Recipients

Abstract

Cytomegalovirus (CMV) infection is one of the most important causes of mortality and morbidity in hematopoietic stem cell transplant (HSCT) recipients. There are many guidelines for CMV prevention, diagnosis, and treatment. However, in resource-limited settings, the implementation of international guidelines is constrained by some differences in epidemiology, diagnostic methods, and drug availability. This study develops a national guideline for CMV management based on the healthcare context in Iran. The Guideline Development Group (GDG) is a multidisciplinary team that consists of experts in hematology, oncology, infectious diseases, virology, pharmacology, epidemiology, and methodology that develops the guideline. To have a systemic approach, a literature review was conducted based on relevant studies about CMV management in HSCT recipients from 2000 to 2025. The quality of evidence is assessed through the GRADE methodology and Delphi process. The guideline includes recommendations for risk stratification, surveillance, diagnostic methods, prophylactic strategies, and management of resistant/refractory infections. However, considering limited access to anti-viral agents such as Letermovir in Iran, alternative approaches are designed to have a feasible and effective protocol. Therefore, the guideline integrates international evidence with local healthcare real settings to provide an implementable protocol for CMV management. The context-adapted guideline results in optimized resource utilization and reduces variability in practice. Considerably, the establishment of a national registry system and periodic updates can strengthen CMV control in Iran healthcare system.