JD: Prevention of cytomegalovirus infection after marrow transplantation. Rev Infect Dis 11:S1691S1705

Primary infection with cytomegalovirus (CMV) in seronegative patients is acquired most commonly from blood products or marrow taken from seropositive donors, whereas recur-rent infection in seropositive patients appears to be derived predominantly from reactiva-tion of latent endogenous virus. Not all infected patients develop symptomatic CMV dis-ease; the factors that determine severityof infection and recoveryare not yet fully defined. The epidemiology of CMV infection indicates that primary infection is preventable by use of seronegative blood products, including marrow. Such techniques should be im-plemented immediately. Leukocyte depletion of blood products is a potential alternative, but both efficacy and logistics of implementation require further study in patients who need large quantities of blood products. The efficacy of passive immunoprophylaxis with immunoglobulins remains uncertain, and this modality cannot be recommended until additional data are available. Among seropositive patients, antiviral agents may be used to suppress CMV infection until periods of improved immunocompetence. Although not effective for the treatment of established CMV infection, intravenous acyclovir signifi-cantly reduced the probability of CMV infection and disease and improved survival i