Enhancing Allo-HCT Outcomes with Prophylactic Letermovir Usage – Single Center Experience

• Published in: Transplantation and cellular therapy 2024-02, Vol.30 (2), p.S437-S437
• Main Authors: Tanase, Alina Daniela, Lipan, Lavinia Eugenia, Enache, Alexandra Oana, Tirnovan, Miruna Elena, Colita, Anca
• Format: Article
• Language: English
• ISSN: 2666-6367; 2666-6367
• DOI: 10.1016/j.jtct.2023.12.627

Cytomegalovirus (CMV) reactivation is a common complication in allogeneic hematopoietic stem cell transplantation (allo-HCT) setting and depends on multiple factors: donor type, the conditioning regimen used, and graft-versus-host diseas (GVHD) strategy. This study's objective is to compare the incidence of clinical significant CMV infection (csCMVi) and CMV disease (CMVd) for patients receiveing allo-HCT treated in Fundeni Clinical Institute before and after the 2021 letermovir prophylaxis (LTV PP) approval in Romania. We conducted a retrospective descriptive analysis of 219 patients without LTV PP and 98 patients receiving LTV PP treated in our center with allo-HCT between January 2017 and December 2022. We evaluated patients according to known high-risk factors for csCMVi and CMVd at 100 days and 1-year: CMV serostatus, type of donor, conditioning regimen and GVHD prophylaxis used. Regarding CMV serostatus we registered a higher prevalence of CMV seropositivity in both cohorts for patients and donors alike. Haploidentical donor was registered for 12% (n=12) and for 13% (n=13) in the group without and LTV PP, respectively. Mismatched unrelated donor (MMUD) was registered for 25% (n=54) in the group without LTV, and for 23% (n=23) in the group with LTV PP, respectively. PTCy was used in 58% (n=126) in the first group and in 74% (n=74) in the second group. We evaluated the incidence of csCMVi and CMVd for each group of patients analysing each risk-group subcategory. Significantly better outcomes were seen with LTV PP. csCMVi at 1-year was seen in 19% (n=19) with LTV PP vs. 42% (n=91) without (Wilcoxon obs value=12,217; p-value=0.0001). CMVd was only seen in the group without LTV with and incidence of 8,7% (n=19) (Wilcoxon obs value=8,87, p=0,003). The results observed in our cohort abide to the ones reported in literature, with better outcomes for patients in the LTV PP group both on overall analysis and for each risk group category. Prophylactic LTV use improves quality of life, overall survival and decreases the readmission rate.