a Dipartimento di Oncoematologia Pediatrica , IRCSS Ospedale Pediatrico Bambino Gesù , Rome , Italy.
b Dipartimento di Scienze Pediatriche , Università di Pavia , Pavia , Italy.
Expert Rev Hematol. 2016 Nov;9(11):1093-1105. doi: 10.1080/17474086.2016.1242406. Epub 2016 Oct 11.
Cytomegalovirus (CMV) still causes significant morbidity and mortality in patients given allogeneic hematopoietic stem cell transplantation (HSCT). Despite effective pharmacotherapy, potentially life-threatening CMV disease occurs nowadays in up to 10% of HSCT recipients; moreover, routinely used anti-CMV agents have been shown to be associated with morbidity. Areas covered: This review examines different issues related to diagnosis and management of CMV infection in HSCT recipients, paying particular attention to the monitoring of CMV-specific immune recovery, approaches of adoptive cell therapy and new antiviral drugs. Expert commentary: Despite advances in diagnostic tests and treatment, there is still room for refining management of CMV in HSCT recipients. Immunological monitoring should be associated in the future to virological monitoring. The safety profile and efficacy of new anti-CMV agents should be compared with that of standard-of-care drugs. Donor-derived, pathogen-specific T cells adoptively transferred after transplantation could contribute to reduce the impact of CMV infection on patient's outcome.
巨细胞病毒（CMV）仍然会导致接受异基因造血干细胞移植（HSCT）的患者出现显著的发病率和死亡率。尽管有有效的药物治疗，但目前仍有多达 10%的 HSCT 受者发生危及生命的 CMV 疾病；此外，常规使用的抗 CMV 药物已被证明与发病率有关。
本综述检查了与 HSCT 受者 CMV 感染的诊断和管理相关的不同问题，特别关注 CMV 特异性免疫恢复的监测、过继细胞治疗方法和新的抗病毒药物。
尽管在诊断测试和治疗方面取得了进展，但在 HSCT 受者中 CMV 的管理仍有改进的空间。免疫监测将来应与病毒学监测相关联。新型抗 CMV 药物的安全性和疗效应与标准治疗药物进行比较。移植后过继转移供体来源的、针对病原体的 T 细胞可能有助于降低 CMV 感染对患者结局的影响。
