Cytomegalovirus infection in the bone marrow transplant recipient

Over the past 5 years, with the introduction of preventive ganciclovir therapy and a better understanding of the immunology of cytomegalovirus (CMV) in bone marrow transplant (BMT) recipients, there has been a significant change in the management of CMV infection. As the field of BMT has moved into this era of prophylaxis, there are new problems posed by CMV infection that require additional attention. The natural course of CMV-associated disease is undergoing a change, with a frame-shifting of disease onset to later times after BMT. Yet, the success of this antiviral prophylaxis has been of central importance of new developments in marrow transplantation. At the same time that these new antiviral approaches have developed, there has been intensive interest in reducing the cost of BMT. With this, there is a concern for use of the available antiviral strategies in the most efficient manner. This article reviews the various management options relating to control of CMV and discusses certain areas relating to new research strategies that promise to provide even better approaches to the problem of CMV in this population.