在造血干细胞移植领域，巨细胞病毒（CMV）感染的管理一直是临床研究和治疗的重点之一。随着新药物的不断出现和预防策略的逐步完善，CMV的管理也迎来了新的进展。在近期召开的第51届欧洲血液与骨髓移植学会年会（EBMT 2025）上，瑞典卡罗林斯卡医学院血液学专家Per Ljungman教授分享了题为《State of the art: CMV management 2025: new ECIL guidelines》（最新进展：2025年CMV管理——新的ECIL指南)的精彩内容。《肿瘤瞭望-血液时讯》现场特邀Per Ljungman教授，就相关话题做进一步分享。
《肿瘤瞭望-血液时讯》巨细胞病毒（CMV）是导致异基因造血干细胞移植患者感染和预后不良的主要原因之一。首先请您简要介绍下当前针对CMV的总体管理策略？
Per Ljungman教授：你说得有道理，但也不完全准确。巨细胞病毒（CMV）确实曾是导致造血干细胞移植患者感染的主要病原体之一，但近年来，在早期诊断和预防方面取得了显著进展，导致其带来的问题有所减少。然而，必须明确的是，每个进行异基因移植的中心都应当制定一套有效的CMV管理策略。目前，抗病毒药物来特莫韦（Letermovir）是最常用的预防方法。若使用得当，近年来CMV严重感染的风险已经显著降低。
Oncology Frontier-Hematology Frontier：Cytomegalovirus (CMV) is one of the main causes of infection and poor prognosis in patients undergoing allogeneic hematopoietic stem cell transplantation. Firstly, could you briefly introduce the current overall management strategy for CMV?
Pro. Per Ljungman：You are right and you are wrong.CMV has been one of the main pathogens in stem cell transplant but recent developments both in early diagnosis and prevention of CMV has made it less of a problem.But certainly, each transplant center doing allogeneic transplants needs to have a management strategy for CMV.And the most common one today would be to give antiviral prophylaxis with a drug called Letermovir.And if that is given properly, the risk for significant CMV infection has become much less in recent years.
《肿瘤瞭望-血液时讯》在本次IDWP工作组会议上，您分享了新版ECIL指南关于CMV管理的内容，可否请您详细介绍下新版ECIL指南在CMV管理上有哪些重要更新？这对临床实践有哪些指导意义？
Per Ljungman教授：正如我在会上所提到的，这是该指南的第三版，每一版都为移植中心提供了最新的管理建议。ECIL是“白血病感染欧洲会议”（European Conference on Infections in Leukemia）的缩写，EBMT是该组织的一个重要组成部分。我们成立了一个工作组，回顾了自2017年上一版发布以来的所有相关文献。指南内容涵盖多个方面，包括诊断、感染监测，尤其重要的是——使用来特莫韦进行CMV预防。最新的进展是，美国目前已批准来特莫韦用于儿童治疗，欧洲预计将在几周内正式批准。这是一个重要的变化，因为此前，来特莫韦在儿童中的使用一直是超说明书的。此外，我们还引入了治疗耐药性CMV感染的新药——马立巴韦（Maribavir），并对此给予了强烈推荐。最后，我们首次将CAR-T细胞治疗和双特异性抗体治疗的患者纳入了CMV管理指南。
Oncology Frontier-Hematology Frontier：At the IDWP meeting, you shared the content of the new ECIL guidelines on CMV management. Could you please provide a detailed introduction to the important updates of the new ECIL guidelines on CMV management? What guiding significance does this have for clinical practice?
Pro. Per Ljungman：Yeah, as I presented at the meeting, it's the third version of the guidelines and each of them provide up-to-date management recommendations for transplant centers. ECIL means European Conference on Infections in Leukemia and EBMT is one integral part of that organization. So we had a working group reviewing literature published since the last version in 2017.And went through a number of different topics including diagnosis, monitoring of infections, but also very significantly and importantly, CMV prophylaxis with Letermovir. The new things that are happening is that in the United States and in Europe, Letermovir is now available and licensed for treatment in children, or in Europe it will be at least in a couple of weeks.And that is a big change because until now it has been off-label for children. We are also introducing new treatments for resistant refractory CMV with a drug called Maribavir that is also receiving a strong recommendation.And finally, we are adding for the first time some CMV guidelines for CAR T-cell treated patients and patients treated with bispecific antibodies.
《肿瘤瞭望-血液时讯》在本次IDWP工作组会议上，专家们还围绕真菌感染管理的挑战进行了探讨，可否请您就此发表下您的看法？
Per Ljungman教授：虽然这不是我主要的研究领域，但我认为重点在于，像细菌、病毒一样，真菌感染耐药问题也日益严峻。耐药真菌的发生率正在上升，气候变化还影响了真菌的生长特性。因而，在一些以前没有真菌的地区，现在开始出现新的真菌种类。所有这些问题在未来几十年都可能带来挑战。
Oncology Frontier-Hematology Frontier：At the IDWP meeting, experts also discussed the challenges of managing fungal infections. Could you please share your views on this?
Pro. Per Ljungman：It's not my primary area of expertise, but I think the key message is that as with both bacteria, in some instances with viruses as well, the antimicrobial resistance is becoming a big problem also in fungal infections. The likelihood that you will find resistant fungi is increasing. The climate change changes the growth particularities of fungi. So you will see new fungi in areas where they have not been present before. And all these things are likely to pose challenges over the forthcoming decades.
《肿瘤瞭望-血液时讯》学术期刊在促进研究成果交流、影响临床实践方面扮演着重要角色，可否请您分享下您关注的HCT感染领域的出版期刊？
Per Ljungman教授：我们刚提到的ECIL指南，接下来将发表在《柳叶刀传染病》（Lancet Infectious Diseases）、《柳叶刀血液学》（Lancet Haematology）和《白血病》（Leukemia）等期刊上。这些是面向欧洲的指南，但《临床感染病》（Clinical Infectious Diseases）与《血液学》（Blood）等期刊在我们领域同样具有重要影响。
Oncology Frontier-Hematology Frontier：Academic journals play an important role in promoting research exchange and influencing clinical practice. Could you please share the published journals in the field of HCT infection that you are interested in?
Pro. Per Ljungman：Well, for example, the ECIL guidelines that we just talked about, there will be several different publications in for example Lancet Infectious Diseases, Lancet Haematology and Leukemia. So these are European targeted guidelines, but of course also Clinical Infectious Diseases and Blood for example are also very important for our field.