This review focuses on recent advances in the field of cytomegalovirus (CMV). The 2 main strategies for CMV prevention are prophylaxis and preemptive therapy. Prophylaxis effectively prevents CMV infection after solid organ transplantation (SOT) but is associated with high rates of neutropenia and delayed-onset postprophylaxis disease. In contrast, preemptive therapy has the advantage of leading to lower rates of CMV disease and robust humoral and T-cell responses. It is widely used in hematopoietic cell transplant recipients but is infrequently utilized after SOT due to logistical considerations, though these may be overcome by novel methods to monitor CMV viremia using self-testing platforms. We review recent developments in CMV immune monitoring, vaccination, and monoclonal antibodies, all of which have the potential to become part of integrated strategies that rely on viral load monitoring and immune responses. We discuss novel therapeutic options for drug-resistant or refractory CMV infection, including maribavir, letermovir, and adoptive T-cell transfer. We also explore the role of donor factors in transmitting CMV after SOT. Finally, we propose a framework with which to approach CMV prevention in the foreseeable future.

中文翻译：

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实体器官和造血细胞移植中的巨细胞病毒感染：证据状况

本综述重点关注巨细胞病毒（CMV）领域的最新进展。CMV 预防的 2 个主要策略是预防和先发制人治疗。预防可以有效预防实体器官移植 (SOT) 后的 CMV 感染，但与中性粒细胞减少症和迟发性预防后疾病的高发生率相关。相比之下，先发制人的治疗具有降低 CMV 疾病发生率和增强体液和 T 细胞反应的优点。它广泛用于造血细胞移植受者，但由于后勤方面的考虑，在 SOT 后很少使用，尽管这些问题可以通过使用自检平台监测 CMV 病毒血症的新方法来克服。我们回顾了 CMV 免疫监测、疫苗接种和单克隆抗体的最新进展，所有这些都有可能成为依赖病毒载量监测和免疫反应的综合策略的一部分。我们讨论了耐药性或难治性巨细胞病毒感染的新治疗方案，包括马里巴韦、莱特莫韦和过继性 T 细胞移植。我们还探讨了供体因素在 SOT 后传播 CMV 中的作用。最后，我们提出了一个在可预见的未来预防 CMV 的框架。