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In allo\u2010HSCT, HCMV seropositivity of the recipient and donor is associated with inferior survival outcomes, and post\u2010transplant HCMV reactivation is a frequent complication, necessitating close viral monitoring and pre\u2010emptive and prophylactic antiviral therapies. We present a review in two parts that focuses on the risk factors, immunological responses and treatment strategies for HCMV infection in allo\u2010HSCT recipients, and also explores current evidence surrounding HCMV reactivation in recipients of chimeric antigen receptor T cell (CAR T) therapies. In the current article (Part 1), the impact of HCMV infection in allo\u2010HSCT and CAR T cell recipients is investigated. HCMV reactivation in allo\u2010HSCT recipients is associated with increased mortality, graft\u2010versus\u2010host disease (GvHD) and other microbial infections. Prominent alterations in T cell and natural killer (NK) cell recovery represent distinct immune reconstitution features associated with HCMV reactivation. Immunological biomarkers to predict HCMV complications have been proposed and their adoption in future immune monitoring strategies may allow individualised risk assessment to guide antiviral treatment decisions. The clinical significance of HCMV reactivation after CAR T cell infusion is yet to be fully determined. Continued viral surveillance and investigation of viral dynamics with correlative studies of immune function are needed in this patient population. Current and emerging strategies for treatment and prevention of HCMV complications in allo\u2010HSCT, including use of letermovir prophylaxis and adoptive HCMV\u2010specific T cell therapies, are explored in the following article (Part 2).<\/jats:p>","DOI":"10.1002\/rmv.70142","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T06:40:09Z","timestamp":1776235209000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Human Cytomegalovirus Infection in Haematopoietic Stem Cell Transplant Recipients and CAR T Cell Recipients\n                    <i>\u2013 PART 1: Risk Factors, Clinical Impact and Immune Response<\/i>"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6540-9337","authenticated-orcid":false,"given":"Danya","family":"Kaplan","sequence":"first","affiliation":[{"name":"Infection, Immunity, and Inflammation School of Medical Sciences Faculty 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Institute for Medical Research  Westmead New South Wales Australia"},{"name":"Department of Haematology Westmead Hospital Blood Transplant and Cell Therapies Program  Sydney New South Wales Australia"},{"name":"Faculty of Medicine and Health Sydney Medical School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8692-4145","authenticated-orcid":false,"given":"Michelle K.","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Peter MacCallum Cancer Centre  Melbourne Victoria Australia"},{"name":"Sir Peter MacCallum Department of Oncology The University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Infectious Diseases Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"National Centre for Infections in Cancer Peter MacCallum Cancer Centre  Melbourne Victoria 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