Risk factors for late cytomegalovirus infection after completing letermovir prophylaxis

Prophylactic use of letermovir (LMV) markedly reduces the incidence of early clinically significant cytomegalovirus (csCMV) infection within the first 100 days after allogeneic hematopoietic cell transplantation (allo-HCT), which improves transplant outcomes. However, some patients eventually develo...

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Bibliographic Details
Published in:International journal of hematology 2022-08, Vol.116 (2), p.258-265
Main Authors: Mori, Yasuo, Harada, Takuya, Yoshimoto, Goichi, Shima, Takahiro, Numata, Akihiko, Jinnouchi, Fumiaki, Yamauchi, Takuji, Kikushige, Yoshikane, Kunisaki, Yuya, Kato, Koji, Takenaka, Katsuto, Akashi, Koichi, Miyamoto, Toshihiro
Format: Article
Language:English
Subjects:
Allografts
Cytomegalovirus
Disease prevention
Donors
Hematology
Hematopoietic stem cells
Immune reconstitution
Immunoglobulin G
Infections
Medicine
Medicine & Public Health
Oncology
Original Article
Prophylaxis
Risk factors
Stem cell transplantation
Transplantation
Transplants & implants
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Summary:Prophylactic use of letermovir (LMV) markedly reduces the incidence of early clinically significant cytomegalovirus (csCMV) infection within the first 100 days after allogeneic hematopoietic cell transplantation (allo-HCT), which improves transplant outcomes. However, some patients eventually develop late-csCMV infection (beyond day 100) after completing LMV prophylaxis. To assess the incidence of late-csCMV infection as well as its risk factors and impacts on transplant outcome, a total of 81 allo-HCT recipients who had not developed early csCMV infection during LMV prophylaxis were retrospectively analyzed. Among them, 23 (28.4%) patients developed late-csCMV infection (until day 180) at a median time of 131 days after transplantation and 30 days after LMV discontinuation, respectively. Late-csCMV infection was correlated with apparent delayed immune reconstitution: patients transplanted from HLA-mismatched donors (hazard ratio [HR] = 13.0, p  = 0.011) or CMV-IgG-negative donors (HR = 2.39, p  = 0.043) had a significantly higher risk. In this study, transplant outcomes did not differ between patients with and without late-csCMV infection. This suggests a need to clarify the efficacy of extended administration of LMV for preventing late-csCMV infection in a larger number of allo-HCT recipients, especially those with “high-risk” donors.
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-022-03348-2