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Advances in CMV infection prevention and treatment after allo-HSCT

机译：Allo-HSCT后CMV感染预防和治疗的进展

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摘要

Cytomegalovirus (CMV) remains a major cause of morbidity and mortality in alloge-neic hematopoietic stem cell transplant (HSCT) recipients. Despite this knowledge, a number of CMV-related diagnostic and therapeutic issues remain critical. No uniform guidance exists for the best strategy to monitor and prevent CMV infection and disease. In particular, we lack standard threshold values for assessing the CMV DNAemia in the monitoring of CMV infection; there is no consensus in the adoption of immu-noglobulin therapy and adoptive transfer of HSCT donor-derived CMV-specific T cells. Furthermore, antiviral drugs used in the preemptive therapy are characterized by high levels of toxicity. Of interest, recent availability of new drugs will probably modify the antiviral strategy in a large proportion of patients. The uncertainty in the management of CMV infections is further complicated by the continuous evolution in the transplantation strategies and the consequent infectious risk. This paper will focus on challenging issues in the monitoring, prevention, and treatment of CMV infections in allo-HSCT populations. Assessment of pretransplant CMV status, immu-nological monitoring after transplant, and CMV disease prevention and therapy strategies will be discussed.
机译：巨细胞病毒（CMV）仍然是异源造血干细胞移植（HSCT）受体中发病率和死亡率的主要原因。尽管有这些知识，但许多与CMV相关的诊断和治疗问题仍然至关重要。对于监测和预防CMV感染和疾病的最佳策略没有统一的指导。特别是，我们缺乏评估CMV感染监测中CMV DNAEMIA的标准阈值。在采用免疫性球蛋白治疗和HSCT供体衍生的CMV特异性T细胞的过继转移方面尚无共识。此外，预先治疗中使用的抗病毒药的特征是高水平的毒性。有趣的是，最近的新药可能会在很大一部分患者中改变抗病毒策略。 CMV感染管理的不确定性因移植策略的持续发展和随之而来的传染风险而进一步复杂化。本文将重点介绍Allo-HSCT种群中CMV感染的监测，预防和治疗中的具有挑战性的问题。将讨论对移植前CMV状态，移植后的免疫性监测以及CMV疾病预防和治疗策略的评估。

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