Real-world efficacy of letermovir prophylaxis for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation: A single-center retrospective analysis

J Infect Chemother. 2022 Sep;28(9):1317-1323. doi: 10.1016/j.jiac.2022.05.019. Epub 2022 Jun 18.

Abstract

Introduction: Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (aHSCT) and is associated with increased mortality. Letermovir (LET) is a novel antiviral drug used to prevent CMV infection.

Methods: We analyzed 111 consecutive patients who underwent aHSCT, retrospectively, to evaluate the efficacy of LET prophylaxis for clinically significant CMV infection (csCMVi) in real-world situations. In addition, we analyzed the influence of LET on transplant outcomes. Thirty-eight patients who were administered LET prophylactically were compared with 73 patients without LET prophylaxis after aHSCT.

Results: On day 180, the cumulative incidence of csCMVi in patients who received LET prophylaxis was significantly lower than that in patients without LET prophylaxis (29.7% vs. 56.2%, P < 0.001). Among the patients who developed csCMVi, the interval from aHSCT to the initiation of preemptive therapy was significantly longer in patients who received LET prophylaxis than in those who did not (129.5 days vs. 42 days, P < 0.001). The six-month overall survival was 86.1% in patients who received LET prophylaxis and 66.8% in the non-LET group (P = 0.035).

Conclusion: LET prophylaxis was highly effective in preventing csCMVi and could potentially improve transplant outcomes, particularly when initiated early after transplantations.

Keywords: Allogeneic HSCT; Cytomegalovirus; Infectious complications in hematological malignancies; Letermovir.

MeSH terms

  • Acetates
  • Antiviral Agents
  • Cytomegalovirus
  • Cytomegalovirus Infections* / drug therapy
  • Cytomegalovirus Infections* / etiology
  • Cytomegalovirus Infections* / prevention & control
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Quinazolines
  • Retrospective Studies

Substances

  • Acetates
  • Antiviral Agents
  • Quinazolines
  • letermovir