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肿瘤患者的疱疹病毒(单纯疱疹病毒、水痘-带状疱疹病毒和巨细胞病毒)抗病毒预防

英文原题:Antiviral prophylaxis against herpesviruses (herpes simplex virus, varicella-zoster virus and cytomegalovirus) among patients with cancer.

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Antiviral prophylaxis against herpesviruses (herpes simplex virus, varicella-zoster virus and cytomegalovirus) among patients with cancer.

PubMed 2026/04/15(内容时间) Curr Opin Infect Dis Q1 · IF 4.5(JCR 2025)

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研究思路按摘要原文分段

被诊断为癌症的患者存在病毒再激活风险,即单纯疱疹病毒(HSV)、水痘-带状疱疹病毒(VZV)和/或巨细胞病毒(CMV)。然而,风险因基础恶性肿瘤和治疗方案的不同而有显著差异。我们综述了抗病毒预防策略的最新证据,重点关注新型免疫疗法和未来方向。

抗病毒预防适用于所有高危患者。letermovir获批用于CMV预防已显著减轻了异基因造血干细胞移植(alloHCT)受者中临床显著感染的负担,近期数据现已支持在移植后使用长达200天。对于中等风险方案,如骨髓瘤治疗和自体造血干细胞移植(autoHCT),抗病毒预防也是VZV预防的基石。较新的嵌合抗原受体(CAR)T细胞和双特异性抗体(BsAb)疗法日益可及;尽管HSV/VZV预防已纳入试验和真实世界治疗方案,最佳持续时间尚不明确,且关于CMV再激活的数据仍在不断涌现。实体瘤是较低风险的队列,但大剂量类固醇、免疫检查点抑制剂和放疗可增加病毒再激活的风险,因此有必要进行密切的临床监测。总结:随着癌症治疗格局的演变,有必要持续研究最佳抗病毒预防方法,以改善患者结局。

展开英文摘要原文

PURPOSE OF REVIEW: Patients diagnosed with cancer are at risk of viral reactivation, namely herpes simplex virus (HSV), varicella-zoster virus (VZV) and/or cytomegalovirus (CMV).

However, the risk varies significantly with underlying malignancy and treatment regimen.

We review the latest evidence for antiviral prophylaxis strategies, focusing on novel immune therapies and future directions. RECENT FINDINGS: Antiviral prophylaxis is indicated for all high-risk patients. The approval of letermovir for CMV prophylaxis has significantly reduced the burden of clinically significant infections in allogeneic hematopoietic stem cell transplant (alloHCT) recipients, and recent data now supports use up to 200 days posttransplant. For intermediate-risk regimens such as myeloma therapies and autologous hematopoietic stem cell transplant (autoHCT), antiviral prophylaxis is also a cornerstone of VZV prevention.

Newer chimeric antigen receptor (CAR) T-cell and bispecific antibody (BsAb) therapies are increasingly available; while HSV/VZV prophylaxis has been incorporated into trial and real-world treatment protocols, optimal duration is unclear and data on CMV reactivation is still emerging.

Solid tumours are a lower risk cohort, but high-dose steroids, immune checkpoint inhibitors and radiotherapy can increase the risk of viral reactivation and, therefore, close clinical monitoring is warranted. SUMMARY: As the cancer treatment landscape evolves, ongoing research into optimal antiviral prophylaxis approaches is necessary to improve patient outcomes.

论文信息

作者
Liu AJ、Zhu VZ、Teh BW、Yong MK
单位
National Centre for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne.Australia
文献类型
综述
期刊
Current opinion in infectious diseases2026 Aug 1
原文标识
PubMed 42068587 · DOI 10.1097/QCO.0000000000001198