Successful prevention and treatment of cytomegalovirus (CMV) infection remains a central focus of clinical care in solid organ and allogeneic hematopoietic cell transplantation. Over the past 5 years, pivotal clinical trials have created new paradigms in CMV prevention, including diverging approaches in HCT and SOT. We review recent advances in CMV risk assessment and progress in antiviral and immune-based strategies for CMV prevention and treatment. We highlight approaches to optimize CMV-specific immunity through vaccination, monoclonal antibodies, and virus-specific T-cells. Observational studies and interventional trials of commercially-available CMV cell-mediated immunity assays for refining preventive and treatment strategies are summarized. Finally, we discuss the importance of enhancing CMV-specific immunity to mitigate the negative impacts of CMV in different transplant settings. CMV infections in recipients of chimeric antigen receptor-T (CAR-T) cell therapies and other immunocompromised populations are growing areas of importance that are beyond the scope of this review.

中文翻译：

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移植中巨细胞病毒感染的当前和未来策略


成功预防和治疗巨细胞病毒 （CMV） 感染仍然是实体器官和同种异体造血细胞移植临床护理的中心重点。在过去的 5 年里，关键的临床试验创造了 CMV 预防的新范式，包括 HCT 和 SOT 的不同方法。我们回顾了 CMV 风险评估的最新进展以及抗病毒和基于免疫的 CMV 预防和治疗策略的进展。我们重点介绍了通过疫苗接种、单克隆抗体和病毒特异性 T 细胞优化 CMV 特异性免疫的方法。总结了市售 CMV 细胞介导的免疫测定用于改进预防和治疗策略的观察性研究和干预试验。最后，我们讨论了增强 CMV 特异性免疫以减轻 CMV 在不同移植环境中的负面影响的重要性。嵌合抗原受体-T （CAR-T） 细胞疗法受者和其他免疫功能低下人群的 CMV 感染是日益增长的重要领域，超出了本综述的范围。