2024 Volume 13 Issue 3 Pages 81-88
Management of cytomegalovirus (CMV) reactivation is a crucial challenge following allogeneic hematopoietic cell transplantation (allo-HCT). The goal is to control CMV reactivation before it progresses to CMV-related diseases. There are several risk factors for CMV reactivation which can be categorized into patient-related, donor-related, transplantation method-related factors, and post-transplantation events. Currently, the most common approach to CMV reactivation involves a prophylactic strategy by letermovir or a presumptive treatment by monitoring the CMV viral load.
CMV reactivation is generally considered to be an independent risk factor for non-relapse mortality and other complications, and several issues remain a matter of debate, including the clinical relationship between CMV and graft-versus-host disease, and the impact of CMV reactivation on leukemia relapse or opportunistic infections. Furthermore, for long-term control of CMV infection post-transplantation, it is essential to rely not only on drug treatments but also on immune control. This review article will present several recent findings regarding CMV immunity after allo-HCT. The fact that many allo-HCT recipients still suffer from CMV reactivation or CMV-related diseases indicates that numerous challenges still need to be addressed. Therefore, it is expected that a more comprehensive strategy against CMV will arise from various perspectives in the future.
