Chung Haerim
Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50‑1 Yonsei‑Ro, Seodaemun‑Gu, Seoul, 03722, Republic of Korea.
Blood Res. 2025 Jun 3;60(1):33. doi: 10.1007/s44313-025-00081-7.
Cytomegalovirus (CMV) infection remains a major complication in recipients of hematopoietic stem cell transplantation (HSCT) and contributes significantly to morbidity and mortality. Effective CMV prevention and management are essential for improving transplant outcomes. Preventive strategies include antiviral prophylaxis and preemptive treatments (PET). Letermovir, a terminase complex inhibitor, has become the standard of care for primary prophylaxis in CMV-seropositive recipients because of its efficacy and favorable safety profile. PET involves regular monitoring of CMV DNAemia via polymerase chain reaction (PCR) and initiation of antiviral therapy, most commonly ganciclovir or valganciclovir, upon detection of early viral reactivation. Refractory or resistant CMV infections present a significant therapeutic challenge and often require switching to a different antiviral class while awaiting genotypic resistance testing. Maribavir, a UL97 kinase inhibitor, has demonstrated superior efficacy and improved tolerability compared to conventional therapies in the phase 3 SOLSTICE trial, making it a promising therapy for refractory or resistant CMV. Optimal CMV management requires a risk-adapted, individualized approach that integrates prophylaxis, early detection, and timely intervention to reduce CMV-related complications.
巨细胞病毒（CMV）感染仍然是造血干细胞移植（HSCT）受者的主要并发症，并且对发病率和死亡率有显著影响。有效的CMV预防和管理对于改善移植结果至关重要。预防策略包括抗病毒预防和抢先治疗（PET）。来特莫韦，一种端粒酶复合物抑制剂，由于其疗效和良好的安全性，已成为CMV血清阳性受者初级预防的标准治疗方法。PET包括通过聚合酶链反应（PCR）定期监测CMV血症，并在检测到早期病毒再激活时启动抗病毒治疗，最常用的是更昔洛韦或缬更昔洛韦。难治性或耐药性CMV感染带来了重大的治疗挑战，并且在等待基因型耐药性检测时通常需要改用不同类别的抗病毒药物。在3期SOLSTICE试验中，马里巴韦，一种UL97激酶抑制剂，与传统疗法相比已显示出卓越的疗效和更好的耐受性，使其成为难治性或耐药性CMV的一种有前景的治疗方法。最佳的CMV管理需要一种风险适应性、个体化的方法，该方法整合预防、早期检测和及时干预以减少CMV相关并发症。
