血液幹細胞移植病人的巨細胞病毒感染：風險因子、診斷監測與處置

Cytomegalovirus Infection in Post-Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Management Strategies

巨細胞病毒(cytomegalovirus, CMV)的感染對於接受血液幹細胞移植(hematopoietic stem cell transplantation, HSCT)的病人來說，是一個重大且可能致命的併發症。作為皰疹病毒家族的一員，在T細胞缺乏的情況下，CMV有可能引起嚴重的問題，包括：肺炎、胃腸炎或視網膜炎等疾病。引發CMV感染的風險因子涵蓋了多個面相：包含捐贈者與受贈者移植前的CMV血清學、使用來自不相關或不匹配捐贈者的造血幹細胞移植、使用抗胸腺細胞球蛋白(anti-thymocyte globulin, ATG)或環磷醯胺(post-transplant cyclophosphamide, PTCy)治療、移植物抗宿主疾病(graft-versus-host disease, GVHD)的產生，以及高劑量皮質類固醇的使用。儘管在診斷工具、預防方式及先發治療(pre-emptive therapy)上已有所進步，但對於處置CMV感染仍有許多挑戰。治療這一類的病人需考量許多因素，這包括考慮病人之前是否接受過抗病毒預防、對CMV疾病的風險評估、病毒負荷量以及抗藥性的可能性。本綜論旨在深入探討在血液幹細胞移植後病人中，CMV感染的風險因子、診斷監測與處置策略。

Cytomegalovirus (CMV) infection is a significant and potentially fatal complication of allogeneic hematopoietic stem cell transplantation (HSCT ). As a herpesvirus, CMV can lead to severe illnesses, such as pneumonia, gastroenteritis, or retinitis, when reactivated, particularly under conditions of T-cell insufficiency. Several risk factors have been identified, including the CMV serostatus of both donors and recipients, use of hematopoietic cell grafts from unrelated or mismatched donors, T-cell depletion in the donor graft, administration of anti-thymocyte globulin or post-transplant cyclophosphamide, development of graft-versus-host disease, and use of high-dose corticosteroids. Despite progress in diagnostic tools, prophylactic measures, and preemptive therapies, managing CMV reactivation remains challenging. The treatment strategy for CMV reactivation increasingly relies on personalized approaches, considering factors such as prior antiviral prophylaxis, patient risk profile for CMV disease, viral load, and potential antiviral drug resistance. This study explored the incidence, risk factors, diagnostic approaches, and management strategies for CMV reactivation among HSCT recipients.