LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM?
Background: Cytomegalovirus (CMV) infection remains the most common clinically significant infection after allogeneic hematopoietic stem cell transplantation (allo-HCT) and is associated with considerable morbidity and mortality. Objectives: The present study was designed to describe and compare...
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PAGEPress Publications
2024-04-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | https://www.mjhid.org/mjhid/article/view/5613 |
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| author | Fabian Herrera |
| author_facet | Fabian Herrera |
| author_sort | Fabian Herrera |
| collection | DOAJ |
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Background: Cytomegalovirus (CMV) infection remains the most common clinically significant infection after allogeneic hematopoietic stem cell transplantation (allo-HCT) and is associated with considerable morbidity and mortality.
Objectives: The present study was designed to describe and compare the incidence of untreated CMV reactivation (uCMVr), clinically significant infection (cs-CMVi) and disease (CMVd), as well as CMV-related hospitalization and outcome of allo-HCT patients, either treated with letermovir (LET) primary prophylaxis or managed with preemptive therapy (PET).
Methods: This is a prospective observational cohort study of adult CMV seropositive allo-HCT patients who either received primary prophylaxis with LET within the first 100 days after HCT or were managed with PET.
Results: The study population comprised 105 patients (28 in the LET group and 77 in the PET group). Compared to the PET group, patients in the LET group received more allo-HCT from alternative donors (54.5% vs. 82.14%, P=0.012). More than half of the patients in both groups were classified as high risk for CMVd. In the LET vs. PET group, cs-CMVi and CMVd developed respectively in 0 vs. 50 (64.94%), P=<0.0001, and 0 vs. 6 (7.79%), P=0.18. In the LET group, uCMVr occurred in 5 (17.8%) and were all considered blips. Hospital admissions related to cs-CMVi or CMVd in the PET group vs. LET group were 47 (61.04%) vs. 0, respectively, P=<0.0001. No differences were observed in 100-day mortality.
Conclusions: LET primary prophylaxis proved effective in preventing cs-CMVi and CMVd and reducing hospitalizations in allo-HCT adults. Blips can occur during prophylaxis and do not require LET discontinuation.
Keywords: letermovir; cytomegalovirus; hematopoietic cell transplantation.
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| format | Article |
| id | doaj-art-93989840741249838e86a81c285fdf57 |
| institution | Kabale University |
| issn | 2035-3006 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-93989840741249838e86a81c285fdf572025-01-03T01:08:40ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062024-04-0116110.4084/MJHID.2024.039LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM?Fabian Herrera0a:1:{s:5:"en_US";s:106:"Infectious Diseases Section, Centro de Educación Médica e Investigaciones Clínicas, Dr. Norberto Quirno";} Background: Cytomegalovirus (CMV) infection remains the most common clinically significant infection after allogeneic hematopoietic stem cell transplantation (allo-HCT) and is associated with considerable morbidity and mortality. Objectives: The present study was designed to describe and compare the incidence of untreated CMV reactivation (uCMVr), clinically significant infection (cs-CMVi) and disease (CMVd), as well as CMV-related hospitalization and outcome of allo-HCT patients, either treated with letermovir (LET) primary prophylaxis or managed with preemptive therapy (PET). Methods: This is a prospective observational cohort study of adult CMV seropositive allo-HCT patients who either received primary prophylaxis with LET within the first 100 days after HCT or were managed with PET. Results: The study population comprised 105 patients (28 in the LET group and 77 in the PET group). Compared to the PET group, patients in the LET group received more allo-HCT from alternative donors (54.5% vs. 82.14%, P=0.012). More than half of the patients in both groups were classified as high risk for CMVd. In the LET vs. PET group, cs-CMVi and CMVd developed respectively in 0 vs. 50 (64.94%), P=<0.0001, and 0 vs. 6 (7.79%), P=0.18. In the LET group, uCMVr occurred in 5 (17.8%) and were all considered blips. Hospital admissions related to cs-CMVi or CMVd in the PET group vs. LET group were 47 (61.04%) vs. 0, respectively, P=<0.0001. No differences were observed in 100-day mortality. Conclusions: LET primary prophylaxis proved effective in preventing cs-CMVi and CMVd and reducing hospitalizations in allo-HCT adults. Blips can occur during prophylaxis and do not require LET discontinuation. Keywords: letermovir; cytomegalovirus; hematopoietic cell transplantation. https://www.mjhid.org/mjhid/article/view/5613letermovir; cytomegalovirus; hematopoietic cell transplantation |
| spellingShingle | Fabian Herrera LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM? Mediterranean Journal of Hematology and Infectious Diseases letermovir; cytomegalovirus; hematopoietic cell transplantation |
| title | LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM? |
| title_full | LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM? |
| title_fullStr | LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM? |
| title_full_unstemmed | LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM? |
| title_short | LETERMOVIR PRIMARY CYTOMEGALOVIRUS PROPHYLAXIS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: COULD INFECTION AND DISEASE NO LONGER BE A SIGNIFICANT PROBLEM? |
| title_sort | letermovir primary cytomegalovirus prophylaxis in allogeneic hematopoietic cell transplant recipients could infection and disease no longer be a significant problem |
| topic | letermovir; cytomegalovirus; hematopoietic cell transplantation |
| url | https://www.mjhid.org/mjhid/article/view/5613 |
| work_keys_str_mv | AT fabianherrera letermovirprimarycytomegalovirusprophylaxisinallogeneichematopoieticcelltransplantrecipientscouldinfectionanddiseasenolongerbeasignificantproblem |