transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2022-14-2-210-225transplantologiya-658Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESЦитомегаловирусная инфекция при трансплантации аллогенных гемопоэтических стволовых клеток: основное клиническое значение и определенияCytomegalovirus infection after allogeneic hematopoietic stem cell transplantation: clinical significance and definitionshttps://orcid.org/0000-0002-2198-4331ДмитроваА. А.DmitrovaA. A.

Анна Александровна Дмитрова, врач-гематолог, отделение интенсивной высокодозной химиотерапии и трансплантации костного мозга с круглосуточным стационаром

125167, Москва, Новый Зыковский пр-д, д. 4

Anna A. Dmitrova, Hematologist at the Department of Intensive High-Dose Chemotherapy and Bone Marrow Transplantation

4 Noviy Zykovskiy Dr., Moscow 125167

dr.admitrova@gmail.comhttps://orcid.org/0000-0001-9431-8316ДроковМ. Ю.DrokovM. Yu.

Михаил Юрьевич Дроков, канд. мед. наук, врач-гематолог, руководитель сектора по изучению иммунных воздействий и осложнений после трансплантации костного мозга

125167, Москва, Новый Зыковский пр-д, д. 4

Mikhail Yu. Drokov, Cand. Sci. (Med.), Hematologist, Head of the Sector for the Study of Immune Effects and Complications after Bone Marrow Transplantation

4 Noviy Zykovskiy Dr., Moscow 125167

https://orcid.org/0000-0003-4668-9379ТуполеваТ. А.TupolevaT. A.

Татьяна Алексеевна Туполева, д-р мед. наук, врач-вирусолог, заведующий отделом вирусологической диагностики

125167, Москва, Новый Зыковский пр-д, д. 4

Tatyana A. Tupoleva, Dr. Sci. (Med.), Virologist, Head of the Virological Diagnosis Department

4 Noviy Zykovskiy Dr., Moscow 125167

https://orcid.org/0000-0001-8188-5557СавченкоВ. Г.SavchenkoV. G.

Валерий Григорьевич Савченко, академик РАН, проф., д-р мед. наук, генеральный директор

125167, Москва, Новый Зыковский пр-д, д. 4

Valeriy G. Savchenko, Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), General Director

4 Noviy Zykovskiy Dr., Moscow 125167

ФГБУ «НМИЦ гематологии» МЗ РФРоссияNational Medical Research Center for HematologyRussian Federation202214062022142210225Copyright © Дмитрова А.А., Дроков М.Ю., Туполева Т.А., Савченко В.Г., 20222022Дмитрова А.А., Дроков М.Ю., Туполева Т.А., Савченко В.Г.Dmitrova A.A., Drokov M.Y., Tupoleva T.A., Savchenko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/658

Цитомегаловирусная инфекция является лидирующей причиной смертности у пациентов после трансплантации аллогенных гемопоэтических стволовых клеток, особенно в ранние сроки.

Одними из наиболее значимых факторов риска развития цитомегаловирусной инфекции у реципиентов аллогенных гемопоэтических стволовых клеток являются цитомегаловирусная серопозитивность донора и (или) реципиента, а также недостаточная и (или) отсроченная реконституция цитомегаловирусных специфических CD4+ и CD8+ Т-лимфоцитов после трансплантации аллогенных гемопоэтических стволовых клеток.

Спектр клинических проявлений разнообразен: как от бессимптомного течения, так и до развития цитомегаловирусной болезни с вовлечением органов-мишеней, что случается в 10–40% случаев. На сегодняшний день доступны публикации, подтверждающие как неблагоприятное, так и «положительное» влияние цитомегаловируса на отдаленные результаты у пациентов после трансплантации аллогенных гемопоэтических стволовых клеток. Острая и хроническая реакция «трансплантат против хозяина» могут также являться факторами риска развития цитомегаловирусной инфекции. В некоторых работах описано влияние цитомегаловирусной инфекции на развитие несостоятельности трансплантата. Однако известен и «противолейкемический эффект» цитомегаловирусной инфекции, когда эпизод цитомегаловирусной инфекции снижает вероятность развития рецидива у пациентов с острым миелоидным лейкозом, хроническим миелолейкозом.

Несмотря на внедрение стратегий профилактической, превентивной и таргетной терапии цитомегаловирусной инфекции, она до сих пор ухудшает посттрансплантационные показатели.

Целью этого обзора стала систематизация современных понятий, применяемых при оценке и лечении цитомегаловирусной инфекции у пациентов после трансплантации аллогенных гемопоэтических стволовых клеток.

Cytomegalovirus infection is one of the critical and life-threatening infectious complications in patients after allogeneic hematopoietic stem cell transplantation. The most significant risk factors for the development of cytomegalovirus infection are cytomegalovirus serostatus of the donor and recipient and delayed reconstitution of cytomegalovirus-specific CD4+ and CD8+ T lymphocytes after allogeneic hematopoietic stem cells transplantation.

The infection may be asymptomatic or may lead to serious complications such as cytomegalovirus disease, which happens in 10-40% of cases. Cytomegalovirus infection has different impact on patients after hematopoietic stem cell transplantation. For instance, acute and chronic graft versus host disease may also be the risk factors for the development of cytomegalovirus infection. There is also information about the influence of cytomegalovirus infection on a graft failure. We also know that cytomegalovirus replication is associated with lower relapse risk in patients with acute myeloid leukemia and chronic myeloid leukemia.

Antiviral prophylaxis and preemptive therapy are good strategies to reduce the risk of the cytomegalovirus infection. Despite this, cytomegalovirus infection is still associated with decreased overall survival and increased non-relapse mortality in recipients of allogeneic stem cells.

The aim of this review is to systematize modern concepts used in the management and treatment of cytomegalovirus infections in patients after hematopoietic stem cell transplantation.

трансплантация аллогенных гемопоэтических стволовых клетокцитомегаловирусная инфекциярезистентная цитомегаловирусная инфекциярефрактерная цитомегаловирусная инфекцияцитомегаловирусная болезньhematopoietic stem cell transplantationcytomegalovirus infectionresistant cytomegalovirus infectionrefractory cytomegalovirus infectioncytomegalovirus diseaseReferencesSousa H, Boutolleau D, Ribeiro J, Teixeira AL, Pinho Vaz C, Campilho F, et al. Cytomegalovirus infection in patients who underwent allogeneic hematopoietic stem cell transplantation in portugal: a five-year retrospective review. Biol Blood Marrow Transplant. 2014;20(12):1958-1967. PMID: 25139217 https://doi.org/10.1016/j.bbmt.2014.08.010Sousa H, Boutolleau D, Ribeiro J, Teixeira AL, Pinho Vaz C, Campilho F, et al. Cytomegalovirus infection in patients who underwent allogeneic hematopoietic stem cell transplantation in portugal: a five-year retrospective review. Biol Blood Marrow Transplant. 2014;20(12):1958-1967. PMID: 25139217 https://doi.org/10.1016/j.bbmt.2014.08.010Teira P, Battiwalla M, Ramana than M, Barrett AJ, Ahn KW, Chen M, et al. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: A CIBMTR analysis. Blood. 2016;127(20):2427–2438. PMID: 26884374 https://doi.org/10.1182/blood-2015-11-679639Teira P, Battiwalla M, Ramana than M, Barrett AJ, Ahn KW, Chen M, et al. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: A CIBMTR analysis. Blood. 2016;127(20):2427–2438. PMID: 26884374 https://doi.org/10.1182/blood-2015-11-679639Sun R-J, Wei Z-J, Liu D-Y, Cao X-Y, Zhang J-P, Xiong M, et al. Efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for 67 pediatric patients with high risk T-cell acute lymphoblastic leukemia (T-ALL). Biol Blood Marrow Trans plant. 2019;25(3):S111–S112. https://doi.org/10.1016/J.BBMT.2018.12.387Sun R-J, Wei Z-J, Liu D-Y, Cao X-Y, Zhang J-P, Xiong M, et al. Efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for 67 pediatric patients with high risk T-cell acute lymphoblastic leukemia (T-ALL). Biol Blood Marrow Trans plant. 2019;25(3):S111–S112. https://doi.org/10.1016/J.BBMT.2018.12.387Zuhair M, Smit G, Wallis G, Jab bar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: а systematic review and meta-analysis. Rev Med Virol. 2019;29(3):e2034. PMID: 30706584 https://doi.org/10.1002/RMV.2034Zuhair M, Smit G, Wallis G, Jab bar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: а systematic review and meta-analysis. Rev Med Virol. 2019;29(3):e2034. PMID: 30706584 https://doi.org/10.1002/RMV.2034Seo S, Cho Y, Park J. Serologic screening of pregnant Korean women for primary human cytomegalovirus infection using IgG avidity test. Korean J Lab Med. 2009;29(6):557–562. PMID: 20046088 https://doi.org/10.3343/KJLM.2009.29.6.557Seo S, Cho Y, Park J. Serologic screening of pregnant Korean women for primary human cytomegalovirus infection using IgG avidity test. Korean J Lab Med. 2009;29(6):557–562. PMID: 20046088 https://doi.org/10.3343/KJLM.2009.29.6.557Boeckh M, Geballe AP. Cytomegalovirus: pathogen, paradigm, and puzzle. J Clin Invest. 2011;121(5):1673–1680. PMID: 21659716 https://doi.org/10.1172/JCI45449Boeckh M, Geballe AP. Cytomegalovirus: pathogen, paradigm, and puzzle. J Clin Invest. 2011;121(5):1673–1680. PMID: 21659716 https://doi.org/10.1172/JCI45449Walter EA, Greenberg PD, Gilbert MJ, Finch RJ, Watanabe KS, Thomas ED, et al. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by trans fer of T-cell clones from the donor. N Engl J Med. 1995;333(16):1038–1044. PMID: 7675046 https://doi.org/10.1056/NEJM199510193331603Walter EA, Greenberg PD, Gilbert MJ, Finch RJ, Watanabe KS, Thomas ED, et al. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by trans fer of T-cell clones from the donor. N Engl J Med. 1995;333(16):1038–1044. PMID: 7675046 https://doi.org/10.1056/NEJM199510193331603Boeckh M, Leisenring W, Riddell SR, Bowden RA, Huang M-L, Myerson D, et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood. 2003;101(2):407–414. PMID: 12393659 https://doi.org/10.1182/BLOOD-2002-03-0993Boeckh M, Leisenring W, Riddell SR, Bowden RA, Huang M-L, Myerson D, et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood. 2003;101(2):407–414. PMID: 12393659 https://doi.org/10.1182/BLOOD-2002-03-0993Bhat V, Joshi A, Sarode R, Chavan P. Cytomegalovirus infection in the bone marrow transplant patient. World J Transplant. 2015;5(4):287–291. PMID: 26722656 https://doi.org/10.5500/WJT.V5.I4.287Bhat V, Joshi A, Sarode R, Chavan P. Cytomegalovirus infection in the bone marrow transplant patient. World J Transplant. 2015;5(4):287–291. PMID: 26722656 https://doi.org/10.5500/WJT.V5.I4.287Ljungman P. CMV infections after hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008;42 Suppl 1:S70–72. PMID: 18724309 https://doi.org/10.1038/bmt.2008.120Ljungman P. CMV infections after hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008;42 Suppl 1:S70–72. PMID: 18724309 https://doi.org/10.1038/bmt.2008.120Cho S-Y, Lee D-G, Kim H-J. Cytomegalovirus infections after hematopoietic stem cell transplantation: current status and future immunotherapy. Int J Mol Sci. 2019;20(11):2666. PMID: 31151230 https://doi.org/10.3390/IJMS20112666Cho S-Y, Lee D-G, Kim H-J. Cytomegalovirus infections after hematopoietic stem cell transplantation: current status and future immunotherapy. Int J Mol Sci. 2019;20(11):2666. PMID: 31151230 https://doi.org/10.3390/IJMS20112666Mattsson J, Ringd én O, Storb R. Graft failure after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2008;14(1Suppl 1):165–170. PMID: 18162238 https://doi.org/10.1016/J.BBMT.2007.10.025Mattsson J, Ringd én O, Storb R. Graft failure after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2008;14(1Suppl 1):165–170. PMID: 18162238 https://doi.org/10.1016/J.BBMT.2007.10.025Einsele H, Ljungman P, Boeckh M. How I treat CMV reactivation after allogeneic hematopoietic stem cell transplantation. Blood. 2020;135(19):1619-1629. PMID: 32202631 https://doi.org/10.1182/BLOOD.2019000956Einsele H, Ljungman P, Boeckh M. How I treat CMV reactivation after allogeneic hematopoietic stem cell transplantation. Blood. 2020;135(19):1619-1629. PMID: 32202631 https://doi.org/10.1182/BLOOD.2019000956Cantoni N, Hirsch HH, Khanna N, Gerull S, Buser A, Bucher C, et al. Evidence for a bidirectional relationship between cytomegalovirus rep lication and acute graft-versus-host disease. Biol Blood Marrow Trans plant. 2010;16(9):1309–1314. PMID: 20353832 https://doi.org/10.1016/J.BBMT.2010.03.020Cantoni N, Hirsch HH, Khanna N, Gerull S, Buser A, Bucher C, et al. Evidence for a bidirectional relationship between cytomegalovirus rep lication and acute graft-versus-host disease. Biol Blood Marrow Trans plant. 2010;16(9):1309–1314. PMID: 20353832 https://doi.org/10.1016/J.BBMT.2010.03.020Suessmuth Y, Betz K, Yu A, Bratrude B, Watkins B, Qayed M, et al. Potent interaction between CMV reactiva tion and GVHD: immunologic evidence for blunting of CMV-driven immune reconstitution in the setting of Gvhd. Blood. 2020;136(Suppl 1):50. https://doi.org/10.1182/BLOOD-2020-141856Suessmuth Y, Betz K, Yu A, Bratrude B, Watkins B, Qayed M, et al. Potent interaction between CMV reactiva tion and GVHD: immunologic evidence for blunting of CMV-driven immune reconstitution in the setting of Gvhd. Blood. 2020;136(Suppl 1):50. https://doi.org/10.1182/BLOOD-2020-141856Green ML, Leisenring WM, Xie H, Walter RB, Mielcarek M, Sandmaier BM, et al. CMV reactivation after allogeneic HCT and relapse risk: evidence for early protection in acute myeloid leukemia. Blood. 2013;122(7):1316–1324. PMID: 23744585 https://doi.org/10.1182/BLOOD-2013-02-487074Green ML, Leisenring WM, Xie H, Walter RB, Mielcarek M, Sandmaier BM, et al. CMV reactivation after allogeneic HCT and relapse risk: evidence for early protection in acute myeloid leukemia. Blood. 2013;122(7):1316–1324. PMID: 23744585 https://doi.org/10.1182/BLOOD-2013-02-487074Elmaagacli AH, Steckel N, Koldehoff M, Hegerfeldt Y, Trenschel R, Ditschkowski M, et al. Early human cytomegalovirus replication after transplantation is associated with a decreased relapse risk: evidence for a putative virus-versus-leukemia effect in acute myeloid leukemia patients. Blood. 2011;118(5):1402–1412. PMID: 21540462 https://doi.org/10.1182/BLOOD-2010-08-304121Elmaagacli AH, Steckel N, Koldehoff M, Hegerfeldt Y, Trenschel R, Ditschkowski M, et al. Early human cytomegalovirus replication after transplantation is associated with a decreased relapse risk: evidence for a putative virus-versus-leukemia effect in acute myeloid leukemia patients. Blood. 2011;118(5):1402–1412. PMID: 21540462 https://doi.org/10.1182/BLOOD-2010-08-304121Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G, et al. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis. 2017;64(1):87–91. PMID: 27682069 https://doi.org/10.1093/cid/ciw668Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G, et al. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis. 2017;64(1):87–91. PMID: 27682069 https://doi.org/10.1093/cid/ciw668Razonable RR, Inoue N, Pinninti SG, Boppana SB, Lazzarotto T, Gabrielli L, et al. Clinical diagnostic testing for human cytomegalovirus infections. The J Infect Dis. 2020;221(Suppl 1):S74–85. PMID: 32134488 https://doi.org/10.1093/INFDIS/JIZ601Razonable RR, Inoue N, Pinninti SG, Boppana SB, Lazzarotto T, Gabrielli L, et al. Clinical diagnostic testing for human cytomegalovirus infections. The J Infect Dis. 2020;221(Suppl 1):S74–85. PMID: 32134488 https://doi.org/10.1093/INFDIS/JIZ601Evans P, Soin A, Wreghitt T, Alexander G. Qualitative and semiquantitative polymerase chain reaction testing for cytomegalovirus DNA in serum allows prediction of CMV related disease in liver transplant recipients. J Clin Pathol. 1998;51(12):914–921. PMID: 10070333 https://doi.org/10.1136/JCP.51.12.914Evans P, Soin A, Wreghitt T, Alexander G. Qualitative and semiquantitative polymerase chain reaction testing for cytomegalovirus DNA in serum allows prediction of CMV related disease in liver transplant recipients. J Clin Pathol. 1998;51(12):914–921. PMID: 10070333 https://doi.org/10.1136/JCP.51.12.914Einsele H, Ehninger G, Steidle M, Vallbracht A, Müller F, Schmidt H, et al. Polymerase chain reaction to evaluate antiviral therapy for cytomegalovirus disease. Lancet. 1991;338(8776):1170-1172. PMID: 1682592 https://doi.org/10.1016/0140-6736(91)92032-WEinsele H, Ehninger G, Steidle M, Vallbracht A, Müller F, Schmidt H, et al. Polymerase chain reaction to evaluate antiviral therapy for cytomegalovirus disease. Lancet. 1991;338(8776):1170-1172. PMID: 1682592 https://doi.org/10.1016/0140-6736(91)92032-WTeng CLJ, Wang PN, Chen YC, Ko BS. Cytomegalovirus management after allogeneic hematopoietic stem cell transplantation: а mini-review. J Microbiol Immunol Infect. 2021;54(3):341–348. PMID: 33514495 https://doi.org/10.1016/J.JMII.2021.01.001Teng CLJ, Wang PN, Chen YC, Ko BS. Cytomegalovirus management after allogeneic hematopoietic stem cell transplantation: а mini-review. J Microbiol Immunol Infect. 2021;54(3):341–348. PMID: 33514495 https://doi.org/10.1016/J.JMII.2021.01.001Breda G, Almeida B, Carstensen S, Bonfim CM, Nogueira MB, Vidal LR, et al. Human cytomegalovirus detection by real-time PCR and pp65-antigen test in hematopoietic stem cell transplant recipients: a challenge in low and middle-income countries. Pathog Glob Health. 2013;107(6):312–319. PMID: 24188241 PMID: 21827433 https://doi.org/10.1179/2047773213Y.0000000114Breda G, Almeida B, Carstensen S, Bonfim CM, Nogueira MB, Vidal LR, et al. Human cytomegalovirus detection by real-time PCR and pp65-antigen test in hematopoietic stem cell transplant recipients: a challenge in low and middle-income countries. Pathog Glob Health. 2013;107(6):312–319. PMID: 24188241 PMID: 21827433 https://doi.org/10.1179/2047773213Y.0000000114Ross S, Novak Z, Pati S, Boppana S. Overview of the diagnosis of cytomegalovirus infection. Infect Disord Drug Targets. 2011;11(5):466–474. https://doi.org/10.2174/187152611797636703Ross S, Novak Z, Pati S, Boppana S. Overview of the diagnosis of cytomegalovirus infection. Infect Disord Drug Targets. 2011;11(5):466–474. https://doi.org/10.2174/187152611797636703Paya C, Holley K, Wiesner R, Balasubramaniam K, Smith T, Espy M, et al. Early diagnosis of cytomegalovirus hepatitis in liver transplant recipients: role of immunostaining, DNA hybridization and culture of hepatic tissue. Hepatology. 1990;12(1):119–126. PMID: 2165031 https://doi.org/10.1002/HEP.1840120119Paya C, Holley K, Wiesner R, Balasubramaniam K, Smith T, Espy M, et al. Early diagnosis of cytomegalovirus hepatitis in liver transplant recipients: role of immunostaining, DNA hybridization and culture of hepatic tissue. Hepatology. 1990;12(1):119–126. PMID: 2165031 https://doi.org/10.1002/HEP.1840120119Chemaly RF, Chou S, Einsele H, Griffiths P, Avery R, Razonable RR, et al. Definitions of resistant and refractory cytomegalovirus infection and disease in transplant recipients for use in clinical trials. Clin Infect Dis. 2019;68(8):1420-1426. PMID: 30137245 https://doi.org/10.1093/CID/CIY696Chemaly RF, Chou S, Einsele H, Griffiths P, Avery R, Razonable RR, et al. Definitions of resistant and refractory cytomegalovirus infection and disease in transplant recipients for use in clinical trials. Clin Infect Dis. 2019;68(8):1420-1426. PMID: 30137245 https://doi.org/10.1093/CID/CIY696Griffiths P. New vaccines and antiviral drugs for cytomegalovirus. J Clin Virol. 2019;116:58–61. PMID: 31132546 https://doi.org/10.1016/J.JCV.2019.04.007Griffiths P. New vaccines and antiviral drugs for cytomegalovirus. J Clin Virol. 2019;116:58–61. PMID: 31132546 https://doi.org/10.1016/J.JCV.2019.04.007Forte E, Zhang Z, Thorp EB, Hummel M. Cytomegalovirus latency and reactivation: an intricate interplay with the host immune response. Front Cell Infect Microbiol. 2020;10:130. PMID: 32296651 https://doi.org/10.3389/FCIMB.2020.00130Forte E, Zhang Z, Thorp EB, Hummel M. Cytomegalovirus latency and reactivation: an intricate interplay with the host immune response. Front Cell Infect Microbiol. 2020;10:130. PMID: 32296651 https://doi.org/10.3389/FCIMB.2020.00130Ljungman P, Brand R, Hoek J, de la Camara R, Cordonnier C, Einsele H, et al. Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the european group for blood and marrow transplantation. Clin Infect Dis. 2014;59(4):473–481. https://doi.org/10.1093/CID/CIU364Ljungman P, Brand R, Hoek J, de la Camara R, Cordonnier C, Einsele H, et al. Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the european group for blood and marrow transplantation. Clin Infect Dis. 2014;59(4):473–481. https://doi.org/10.1093/CID/CIU364Styczynski J. Who is the patient at risk of CMV recurrence: a review of the current scientific evidence with a focus on hematopoietic cell transplantation. Infect Dis Ther. 2018;7(1):1–16. PMID: 29204910 https://doi.org/10.1007/S40121-017-0180-ZStyczynski J. Who is the patient at risk of CMV recurrence: a review of the current scientific evidence with a focus on hematopoietic cell transplantation. Infect Dis Ther. 2018;7(1):1–16. PMID: 29204910 https://doi.org/10.1007/S40121-017-0180-ZBoeckh M, Ljungman P. How we treat cytomegalovirus in hematopoi etic cell transplant recipients. Blood. 2009;113(23):5711–5719. PMID: 19299333 https://doi.org/10.1182/BLOOD-200810-143560Boeckh M, Ljungman P. How we treat cytomegalovirus in hematopoi etic cell transplant recipients. Blood. 2009;113(23):5711–5719. PMID: 19299333 https://doi.org/10.1182/BLOOD-200810-143560Asano-Mori Y, Kanda Y, Oshima K, Kako S, Shinohara A, Nakasone H, et al. Clinical features of late cytomega lovirus infection after hematopoietic stem cell transplantation. Int J Hematol. 2008;87(3):310–318. PMID: 18320138 https://doi.org/10.1007/S12185-008-0051-1Asano-Mori Y, Kanda Y, Oshima K, Kako S, Shinohara A, Nakasone H, et al. Clinical features of late cytomega lovirus infection after hematopoietic stem cell transplantation. Int J Hematol. 2008;87(3):310–318. PMID: 18320138 https://doi.org/10.1007/S12185-008-0051-1Han SH, Yoo SG, Han K Do, La Y, Kwon DE, Lee KH. The incidence and effect of cytomegalovirus disease on mortality in transplant recipients and general population: real-world nationwide cohort data. Int J Med Sci. 2021;18(14):3333–3341. PMID: 34400903 https://doi.org/10.7150/IJMS.62621Han SH, Yoo SG, Han K Do, La Y, Kwon DE, Lee KH. The incidence and effect of cytomegalovirus disease on mortality in transplant recipients and general population: real-world nationwide cohort data. Int J Med Sci. 2021;18(14):3333–3341. PMID: 34400903 https://doi.org/10.7150/IJMS.62621Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34(8):1094–1097. PMID: 11914998 https://doi.org/10.1086/339329Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34(8):1094–1097. PMID: 11914998 https://doi.org/10.1086/339329Razonable R. Management strategies for cytomegalovirus infection and disease in solid organ transplant recipients. Infect Dis Clin North Am. 2013;27(2):317–342. PMID: 23714343 https://doi.org/10.1016/J.IDC.2013.02.005Razonable R. Management strategies for cytomegalovirus infection and disease in solid organ transplant recipients. Infect Dis Clin North Am. 2013;27(2):317–342. PMID: 23714343 https://doi.org/10.1016/J.IDC.2013.02.005Dioverti M, Razonable R. Clinical utility of cytomegalovirus viral load in solid organ transplant recipients. Curr Opin Infect Diss. 2015;28(4):317–322. PMID: 26098497 https://doi.org/10.1097/QCO.0000000000000173Dioverti M, Razonable R. Clinical utility of cytomegalovirus viral load in solid organ transplant recipients. Curr Opin Infect Diss. 2015;28(4):317–322. PMID: 26098497 https://doi.org/10.1097/QCO.0000000000000173Bentley S. Bone marrow connective tissue and the haemopoietic microenvironment. Br J Haematol. 1982;50(1):1–6. PMID: 7034766 https://doi.org/10.1111/J.1365-2141.1982.TB01884.XBentley S. Bone marrow connective tissue and the haemopoietic microenvironment. Br J Haematol. 1982;50(1):1–6. PMID: 7034766 https://doi.org/10.1111/J.1365-2141.1982.TB01884.XLjungman P, de la Camara R, Robin C, Crocchiolo R, Einsele H, Hill JA, et al. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19(8):e260–e272. PMID: 31153807 https://doi.org/10.1016/S1473-3099(19)30107-0Ljungman P, de la Camara R, Robin C, Crocchiolo R, Einsele H, Hill JA, et al. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19(8):e260–e272. PMID: 31153807 https://doi.org/10.1016/S1473-3099(19)30107-0Mainou M, Alahdab F, Tobian AAR, Asi N, Mohammed K, Murad MH, et al. Reducing the risk of transfusion-transmitted cytomegalovirus infection: a systematic review and meta-analysis. Transfusion. 2016;56(6 Pt2):1569–1580. PMID: 26826015 https://doi.org/10.1111/TRF.13478Mainou M, Alahdab F, Tobian AAR, Asi N, Mohammed K, Murad MH, et al. Reducing the risk of transfusion-transmitted cytomegalovirus infection: a systematic review and meta-analysis. Transfusion. 2016;56(6 Pt2):1569–1580. PMID: 26826015 https://doi.org/10.1111/TRF.13478Nichols WG, Price TH, Gooley T, Corey L, Boeckh M. Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products. Blood. 2003;101(10):4195–4200. PMID: 12531791 https://doi.org/10.1182/BLOOD-2002-10-3143Nichols WG, Price TH, Gooley T, Corey L, Boeckh M. Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products. Blood. 2003;101(10):4195–4200. PMID: 12531791 https://doi.org/10.1182/BLOOD-2002-10-3143Ljungman P, de la Camara R, Cordonnier C, Einsele H, Engelhard D, Reusser P, et al. Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with hematological malignancies and after SCT. Bone Marrow Transplant. 2008;42(4):227–240. PMID: 18587440 https://doi.org/10.1038/bmt.2008.162Ljungman P, de la Camara R, Cordonnier C, Einsele H, Engelhard D, Reusser P, et al. Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with hematological malignancies and after SCT. Bone Marrow Transplant. 2008;42(4):227–240. PMID: 18587440 https://doi.org/10.1038/bmt.2008.162Jakharia N, Howard D, Riedel DJ. CMV Infection in hematopoietic stem cell transplantation: prevention and treatment strategies. Curr Treat Options Infect Dis. 2021;13(3):123–140. PMID: 34305463 https://doi.org/10.1007/S40506-021-00253-WJakharia N, Howard D, Riedel DJ. CMV Infection in hematopoietic stem cell transplantation: prevention and treatment strategies. Curr Treat Options Infect Dis. 2021;13(3):123–140. PMID: 34305463 https://doi.org/10.1007/S40506-021-00253-WSolano C, Gim énez E, Pi ñana JL, Hernández-Boluda JC, Amat P, Vinuesa V, et al. When should preemp tive antiviral therapy for active CMV infection be withdrawn from allogeneic stem cell transplant recipients? Bone Marrow Transplant. 2017;52(10):1448-1451. PMID: 28581458 https://doi.org/10.1038/bmt.2017.109Solano C, Gim énez E, Pi ñana JL, Hernández-Boluda JC, Amat P, Vinuesa V, et al. When should preemp tive antiviral therapy for active CMV infection be withdrawn from allogeneic stem cell transplant recipients? Bone Marrow Transplant. 2017;52(10):1448-1451. PMID: 28581458 https://doi.org/10.1038/bmt.2017.109Martín-Gandul C, Pérez-Romero P, Sánchez M, Bernal G, Suárez G, Sobrino M, et al. Determination, validation and standardization of a CMV DNA cut-off value in plasma for preemptive treatment of CMV infection in solid organ transplant recipients at lower risk for CMV infection. J Clin Virol. 2013;56(1):13–18. PMID: 23131346 https://doi.org/10.1016/J.JCV.2012.09.017Martín-Gandul C, Pérez-Romero P, Sánchez M, Bernal G, Suárez G, Sobrino M, et al. Determination, validation and standardization of a CMV DNA cut-off value in plasma for preemptive treatment of CMV infection in solid organ transplant recipients at lower risk for CMV infection. J Clin Virol. 2013;56(1):13–18. PMID: 23131346 https://doi.org/10.1016/J.JCV.2012.09.017Green ML, Leisenring W, Stachel D, Pergam SA, Sandmaier BM, Wald A, et al. Efficacy of a viral load-based, riskadapted, preemptive treatment stra tegy for prevention of cytomegalovirus disease after hematopoietic cell transplantation. Biol Blood Marrow Trans plant. 2012;18(11):1687–1699. PMID: 22683614 https://doi.org/10.1016/J.BBMT.2012.05.015Green ML, Leisenring W, Stachel D, Pergam SA, Sandmaier BM, Wald A, et al. Efficacy of a viral load-based, riskadapted, preemptive treatment stra tegy for prevention of cytomegalovirus disease after hematopoietic cell transplantation. Biol Blood Marrow Trans plant. 2012;18(11):1687–1699. PMID: 22683614 https://doi.org/10.1016/J.BBMT.2012.05.015Демин М.В., Тихомиров Д.С., Бидерман Б.В., Глинщикова О.А., Дроков М.Ю., Судариков А.Б. и др. Мутации в гене UL97 цитомегаловируса, ассоциированные с устойчивостью к ганцикловиру, у реципиентов аллогенных гемопоэтических стволовых клеток. Клиническая микробиология и антимикробная химиотерапия. 2019;21(4):352–357. https://doi.org/10.36488/CMAC.2019.4.352-357Demin MV, Tikhomirov DS, Bider man BV, Glinshchikova OA, Drokov MY, Sudarikov AB, et al. Mutations in the cytomegalovirus UL97 gene asso ciated with ganciclovir resistance in recipients of allogeneic hematopoietic stem cell transplants. Clinical Microbiology and Antimicrobial Chemotherapy. 2019;21(4):352–357. (In Russ.). https://doi.org/10.36488/CMAC.2019.4.352-357Демин М.В., Тихомиров Д.С., Бидерман Б.В., Глинщикова О.А., Судариков А.Б., Туполева Т.А. и др. Мутации в гене фосфотрансферазы цитомегаловируса, вызывающие устойчивость к ганцикловиру, у пациентов с иммунодефицитом. Вестник гематологии. 2020;16(3):40–41.Demin MV, Tikhomirov DS, Biderman BV, Glinshchikova OA, Sudarikov AB, Tupoleva TA, et al. Mutatsii v gene fosfotransferazy tsitomegalovirusa, vyzyvayushchie ustoychivost' k gantsikloviru, u patsientov s immunodefitsitom. Vestnik gematologii. 2020;16(3):40–41. (In Russ.).Papanicolaou GA, Silveira FP, Langston AA, Pereira MR, Avery RK, Uknis M, et al. Maribavir for refractory or resistant cytomegalovirus infections in hematopoietic-cell or solid-organ transplant recipients: a randomized, dose-ranging, double-blind, phase 2 study. Clin Infect Dis. 2019;68(8):1255–1264. PMID: 30329038 https://doi.org/10.1093/CID/CIY706Papanicolaou GA, Silveira FP, Langston AA, Pereira MR, Avery RK, Uknis M, et al. Maribavir for refractory or resistant cytomegalovirus infections in hematopoietic-cell or solid-organ transplant recipients: a randomized, dose-ranging, double-blind, phase 2 study. Clin Infect Dis. 2019;68(8):1255–1264. PMID: 30329038 https://doi.org/10.1093/CID/CIY706Liu J, Kong J, Chang YJ, Chen H, Chen YH, Han W, et al. Patients with refractory cytomegalovirus (CMV) infection following allogeneic haematopoietic stem cell transplantation are at high risk for CMV disease and nonrelapse mortality. Clin Microbiol Infect. 2015;21(12):1121.e9–1121.e15. PMID: 26093077 https://doi.org/10.1016/J.CMI.2015.06.009Liu J, Kong J, Chang YJ, Chen H, Chen YH, Han W, et al. Patients with refractory cytomegalovirus (CMV) infection following allogeneic haematopoietic stem cell transplantation are at high risk for CMV disease and nonrelapse mortality. Clin Microbiol Infect. 2015;21(12):1121.e9–1121.e15. PMID: 26093077 https://doi.org/10.1016/J.CMI.2015.06.009Grefte A, Giessen M van der, Son W van, The TH. Circulating cytomegalovirus (CMV)-infected endothelial cells in patients with an active CMV infection. J Infect Dis. 1993;167(2):270–277. PMID: 8380609 https://doi.org/10.1093/INFDIS/167.2.270Grefte A, Giessen M van der, Son W van, The TH. Circulating cytomegalovirus (CMV)-infected endothelial cells in patients with an active CMV infection. J Infect Dis. 1993;167(2):270–277. PMID: 8380609 https://doi.org/10.1093/INFDIS/167.2.270Cantoni N, Hirsch HH, Khanna N, Gerull S, Buser A, Bucher C, et al. Evidence for a bidirectional relationship between cytomegalovirus rep lication and acute graft-versus-host disease. Biol Blood Marrow Trans plant. 2010;16(9):1309–1314. PMID: 20353832 https://doi.org/10.1016/J.BBMT.2010.03.020Cantoni N, Hirsch HH, Khanna N, Gerull S, Buser A, Bucher C, et al. Evidence for a bidirectional relationship between cytomegalovirus rep lication and acute graft-versus-host disease. Biol Blood Marrow Trans plant. 2010;16(9):1309–1314. PMID: 20353832 https://doi.org/10.1016/J.BBMT.2010.03.020Löunnqvist B, Ringdegn O, Ljungman P, Wahren B, Gahrton G. Reduced risk of recurrent leukaemia in bone marrow transplant recipi ents after cytomegalovirus infec tion. Br J Haematol. 1986;63(4):671–679. PMID: 3015193 https://doi.org/10.1111/J.1365-2141.1986.TB07551.XLöunnqvist B, Ringdegn O, Ljungman P, Wahren B, Gahrton G. Reduced risk of recurrent leukaemia in bone marrow transplant recipi ents after cytomegalovirus infec tion. Br J Haematol. 1986;63(4):671–679. PMID: 3015193 https://doi.org/10.1111/J.1365-2141.1986.TB07551.XBehrendt C, Rosenthal J, Bolotin E, Nakamura R, Zaia J, Forman S. Donor and recipient CMV serostatus and outcome of pediatric allogeneic HSCT for acute leukemia in the era of CMV-preemptive therapy. Biol Blood Marrow Transplant. 2009;15(1):54–60. PMID: 19135943 https://doi.org/10.1016/J.BBMT.2008.10.023Behrendt C, Rosenthal J, Bolotin E, Nakamura R, Zaia J, Forman S. Donor and recipient CMV serostatus and outcome of pediatric allogeneic HSCT for acute leukemia in the era of CMV-preemptive therapy. Biol Blood Marrow Transplant. 2009;15(1):54–60. PMID: 19135943 https://doi.org/10.1016/J.BBMT.2008.10.023Elmaagacli AH, Steckel N, Koldehoff M, Hegerfeldt Y, Trenschel R, Ditschkowski M, et al. Early human cytomegalovirus replication after transplantation is associated with a decreased relapse risk: evidence for a putative virus-versus-leukemia effect in acute myeloid leukemia patients. Blood. 2011;118(5):1402-1412. PMID: 21540462 https://doi.org/10.1182/BLOOD-2010-08-304121Elmaagacli AH, Steckel N, Koldehoff M, Hegerfeldt Y, Trenschel R, Ditschkowski M, et al. Early human cytomegalovirus replication after transplantation is associated with a decreased relapse risk: evidence for a putative virus-versus-leukemia effect in acute myeloid leukemia patients. Blood. 2011;118(5):1402-1412. PMID: 21540462 https://doi.org/10.1182/BLOOD-2010-08-304121Green M, Leisenring W, Xie H, Walter R, Mielcarek M, Sandmaier B, et al. CMV reactivation after allogeneic HCT and relapse risk: evidence for early protection in acute myeloid leukemia. Blood. 2013;122(7):1316–1324. PMID: 23744585 https://doi.org/10.1182/BLOOD-2013-02-487074Green M, Leisenring W, Xie H, Walter R, Mielcarek M, Sandmaier B, et al. CMV reactivation after allogeneic HCT and relapse risk: evidence for early protection in acute myeloid leukemia. Blood. 2013;122(7):1316–1324. PMID: 23744585 https://doi.org/10.1182/BLOOD-2013-02-487074Ito S, Pophali P, CO W, Koklanaris E, Superata J, Fahle G, et al. CMV reactivation is associated with a lower incidence of relapse after allo-SCT for CML. Bone Marrow Transplant. 2013;48(10):1313-1316. PMID: 23562969 https://doi.org/10.1038/BMT.2013.49Ito S, Pophali P, CO W, Koklanaris E, Superata J, Fahle G, et al. CMV reactivation is associated with a lower incidence of relapse after allo-SCT for CML. Bone Marrow Transplant. 2013;48(10):1313-1316. PMID: 23562969 https://doi.org/10.1038/BMT.2013.49Yoon J-H, Lee S, Kim H-J, Jeon Y-W, Lee S-E, Cho B-S, et al. Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission. Oncotarget. 2016;7(13):17230-17241. PMID: 26883100 https://doi.org/10.18632/ONCOTARGET.7347Yoon J-H, Lee S, Kim H-J, Jeon Y-W, Lee S-E, Cho B-S, et al. Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission. Oncotarget. 2016;7(13):17230-17241. PMID: 26883100 https://doi.org/10.18632/ONCOTARGET.7347Elmaagacli AH, Koldehoff M. Cytomegalovirus replication redu ces the relapse incidence in patients with acute myeloid leukemia. Blood. 2016;128(3):456–459. PMID: 27216219 https://doi.org/10.1182/BLOOD-2016-04-713644Elmaagacli AH, Koldehoff M. Cytomegalovirus replication redu ces the relapse incidence in patients with acute myeloid leukemia. Blood. 2016;128(3):456–459. PMID: 27216219 https://doi.org/10.1182/BLOOD-2016-04-713644Cooley S, Weisdorf D, Guethlein L, Klein J, Wang T, Le C, et al. Donor selection for natural killer cell receptor genes leads to superior survival after unrelated transplantation for acute myelogenous leukemia. Blood. 2010;116(14):2411-2419. PMID: 20581313 https://doi.org/10.1182/BLOOD-2010-05-283051Cooley S, Weisdorf D, Guethlein L, Klein J, Wang T, Le C, et al. Donor selection for natural killer cell receptor genes leads to superior survival after unrelated transplantation for acute myelogenous leukemia. Blood. 2010;116(14):2411-2419. PMID: 20581313 https://doi.org/10.1182/BLOOD-2010-05-283051Scheper W, van Dorp S, Kersting S, Pietersma F, Lindemans C, Hol S, et al. γδT cells elicited by CMV reactivation after allo-SCT cross-recognize CMV and leukemia. Leukemia. 2013;27(6):1328-1338. PMID: 23277330 https://doi.org/10.1038/LEU.2012.374Scheper W, van Dorp S, Kersting S, Pietersma F, Lindemans C, Hol S, et al. γδT cells elicited by CMV reactivation after allo-SCT cross-recognize CMV and leukemia. Leukemia. 2013;27(6):1328-1338. PMID: 23277330 https://doi.org/10.1038/LEU.2012.374Zhang Y-L, Zhu Y, Xiao Q, Wang L, Liu L, Luo X-H. Cytomegalovirus infection is associated with AML relapse after allo-HSCT: a meta-analysis of observational studies. Anт Hematol. 2019;98(4):1009–1020. PMID: 30666434 https://doi.org/10.1007/S00277-018-3585-1Zhang Y-L, Zhu Y, Xiao Q, Wang L, Liu L, Luo X-H. Cytomegalovirus infection is associated with AML relapse after allo-HSCT: a meta-analysis of observational studies. Anт Hematol. 2019;98(4):1009–1020. PMID: 30666434 https://doi.org/10.1007/S00277-018-3585-1Solano C, Vázquez L, Giménez E, de la Cámara R, Albert E, Rovira M, et al. Clinical outcomes of allogeneic hematopoietic stem cell transplant recipients developing Cytomegalovirus DNAemia prior to engraftment. Bone Marrow Transplantat. 2021;56(6):1281–1290. PMID: 33319853 https://doi.org/10.1038/s41409-020-01157-xSolano C, Vázquez L, Giménez E, de la Cámara R, Albert E, Rovira M, et al. Clinical outcomes of allogeneic hematopoietic stem cell transplant recipients developing Cytomegalovirus DNAemia prior to engraftment. Bone Marrow Transplantat. 2021;56(6):1281–1290. PMID: 33319853 https://doi.org/10.1038/s41409-020-01157-xJeljeli M, Gu érin-El Khourouj V, Porcher R, Fahd M, Leveillé S, Yakouben K, et al. Relationship between cytomegalovirus (CMV) reactivation, CMV-driven immunity, overall immune recovery and graft-versus-leukaemia effect in children. Br J Hhaematol. 2014;166(2):229–239. PMID: 24702221 https://doi.org/10.1111/BJH.12875Jeljeli M, Gu érin-El Khourouj V, Porcher R, Fahd M, Leveillé S, Yakouben K, et al. Relationship between cytomegalovirus (CMV) reactivation, CMV-driven immunity, overall immune recovery and graft-versus-leukaemia effect in children. Br J Hhaematol. 2014;166(2):229–239. PMID: 24702221 https://doi.org/10.1111/BJH.12875Jang J, Kim S, Cheong J, Hyun S, Kim Y, Kim Y, et al. Early CMV rep lication and subsequent chronic GVHD have a significant anti-leukemic effect after allogeneic HSCT in acute myeloid leukemia. Ann Hematol. 2015;94(2):275–282. PMID: 25135450 https://doi.org/10.1007/S00277-014-2190-1Jang J, Kim S, Cheong J, Hyun S, Kim Y, Kim Y, et al. Early CMV rep lication and subsequent chronic GVHD have a significant anti-leukemic effect after allogeneic HSCT in acute myeloid leukemia. Ann Hematol. 2015;94(2):275–282. PMID: 25135450 https://doi.org/10.1007/S00277-014-2190-1Ozdemir Z, Civriz Bozdağ S. Graft failure after allogeneic hematopoietic stem cell transplantation. Transfusion and apheresis science. 2018;57(2):163–167. PMID: 29724627 https://doi.org/10.1016/J.TRANSCI.2018.04.014Ozdemir Z, Civriz Bozdağ S. Graft failure after allogeneic hematopoietic stem cell transplantation. Transfusion and apheresis science. 2018;57(2):163–167. PMID: 29724627 https://doi.org/10.1016/J.TRANSCI.2018.04.014Hutt D. Engraftment, graft failure, and rejection. In: The european blood and marrow transplantation textbook for nurses: under the auspices of EBMT. Cham: Springer; 2018. Ch. 13. https://doi.org/10.1007/978-3-319-50026-3_13Hutt D. Engraftment, graft failure, and rejection. In: The european blood and marrow transplantation textbook for nurses: under the auspices of EBMT. Cham: Springer; 2018. Ch. 13. https://doi.org/10.1007/978-3-319-50026-3_13Locatelli F, Lucarelli B, Merli P. Current and future approaches to treat graft failure after allogeneic hematopoietic stem cell transplantation. Expert Opin Pharmacother. 2014;15(1):23–36. PMID: 24156789 https://doi.org/10.1517/14656566.2014.852537Locatelli F, Lucarelli B, Merli P. Current and future approaches to treat graft failure after allogeneic hematopoietic stem cell transplantation. Expert Opin Pharmacother. 2014;15(1):23–36. PMID: 24156789 https://doi.org/10.1517/14656566.2014.852537Solano C, Gim é nez E, Albert E, Mateo E, Gómez M, Goterris R, et al. Preengraftment cytomegalovirus DNAemia in allogeneic hematopoietic stem cell transplant recipients: incidence, risk factors, and clinical outcomes. Bone Marrow Transplantat. 2019;5(1):90–98. PMID: 29899574 https://doi.org/10.1038/s41409-018-0251-0Solano C, Gim é nez E, Albert E, Mateo E, Gómez M, Goterris R, et al. Preengraftment cytomegalovirus DNAemia in allogeneic hematopoietic stem cell transplant recipients: incidence, risk factors, and clinical outcomes. Bone Marrow Transplantat. 2019;5(1):90–98. PMID: 29899574 https://doi.org/10.1038/s41409-018-0251-0Bunchorntavakul C, Reddy K. Epstein-Barr Virus and cytomegalovirus infections of the liver. Gastroenterology clinics of North America. 2020;49(2):331–346. PMID: 32389366 https://doi.org/10.1016/J.GTC.2020.01.008Bunchorntavakul C, Reddy K. Epstein-Barr Virus and cytomegalovirus infections of the liver. Gastroenterology clinics of North America. 2020;49(2):331–346. PMID: 32389366 https://doi.org/10.1016/J.GTC.2020.01.008O’Grady J, Alexander G, Sutherland S, Donaldson P, Harvey F, Port mann B, et al. Cytomegalovirus infection and donor/recipient HLA antigens: interdependent co-factors in patho genesis of vanishing bile-duct syn drome after liver transplantation. Lancet. 1988;2(8606):302–305. https://doi.org/10.1016/S0140-6736(88)92356-2O’Grady J, Alexander G, Sutherland S, Donaldson P, Harvey F, Port mann B, et al. Cytomegalovirus infection and donor/recipient HLA antigens: interdependent co-factors in patho genesis of vanishing bile-duct syn drome after liver transplantation. Lancet. 1988;2(8606):302–305. https://doi.org/10.1016/S0140-6736(88)92356-2Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol. 2011;3(4):83–94. PMID: 21603030 https://doi.org/10.4254/WJH.V3.I4.83Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol. 2011;3(4):83–94. PMID: 21603030 https://doi.org/10.4254/WJH.V3.I4.83Gatault P, Halimi J, Forconi C, Thibault G, Barbet C, Mérieau E, et al. CMV infection in the donor and increased kidney graft loss: impact of full HLA-I mismatch and posttransplantation CD8(+) cell reduction. Am J Transplant. 2013;13(8):2119–2129. PMID: 23731368 https://doi.org/10.1111/AJT.12298Gatault P, Halimi J, Forconi C, Thibault G, Barbet C, Mérieau E, et al. CMV infection in the donor and increased kidney graft loss: impact of full HLA-I mismatch and posttransplantation CD8(+) cell reduction. Am J Transplant. 2013;13(8):2119–2129. PMID: 23731368 https://doi.org/10.1111/AJT.12298Razonable R, Rivero A, Rodriguez A, Wilson J, Daniels J, Jenkins G, et al. Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir. J Infect Dis. 2001;184(11):1461–1464. PMID: 11709790 https://doi.org/10.1086/324516Razonable R, Rivero A, Rodriguez A, Wilson J, Daniels J, Jenkins G, et al. Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir. J Infect Dis. 2001;184(11):1461–1464. PMID: 11709790 https://doi.org/10.1086/324516van Ree RM, de Vries APJ, Zelle DM, de Vries LV, Oterdoom LH, Gans ROB, et al. Latent cytomegalovirus infection is an independent risk factor for late graft failure in renal transplant recipients. Med Sci Monit. 2011;17(11):CR609–617. PMID: 22037739 https://doi.org/10.12659/MSM.882045van Ree RM, de Vries APJ, Zelle DM, de Vries LV, Oterdoom LH, Gans ROB, et al. Latent cytomegalovirus infection is an independent risk factor for late graft failure in renal transplant recipients. Med Sci Monit. 2011;17(11):CR609–617. PMID: 22037739 https://doi.org/10.12659/MSM.882045

The authors declare that there are no conflicts of interest present.