Efficacy of prophylactic letermovir for cytomegalovirus reactivation in hematopoietic cell transplantation: a multicenter real-world data.
Yasuo MoriFumiaki JinnouchiKatsuto TakenakaTakatoshi AokiTakuro KuriyamaMasanori KadowakiJun OdawaraToshiyuki UenoKentaro KohnoTakuya HaradaGoichi YoshimotoKen TakaseHideho HenzanKoji KatoYoshikiyo ItoTomohiko KamimuraYuju OhnoRyosuke OgawaTetsuya EtoKoji NagafujiKoichi AkashiToshihiro MiyamotoPublished in: Bone marrow transplantation (2020)
A novel anti-cytomegalovirus (CMV) agent, letermovir (LMV), could reportedly improve the outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) recipients because of its high potential to prevent CMV reactivation. Therefore, 685 Japanese allo-HCT recipients, of whom ~80% had a high risk of CMV reactivation, were retrospectively analyzed to assess the impacts of prophylactic LMV on the incidence of clinically significant CMV (csCMV) infection as well as their transplant outcome. By comparing 114 patients who received LMV prophylaxis for a median 92 days to 571 patients without prophylaxis, we observed that prophylactic LMV could significantly (1) reduce the 180-day cumulative incidence of csCMV infection (44.7 vs. 72.4%, p < 0.001), (2) delay the median time until initiation of CMV antigenemia-guided preemptive therapy (90 vs. 36 days, p < 0.001), (3) shorten the duration of anti-CMV preemptive treatment (21 vs. 25 days, p = 0.006), and (4) improve the overall survival rate at 180 days after transplant (80.4 vs. 73.0%, p = 0.033) with a trend of lower non-relapse mortality (8.9 vs. 14.9%, p = 0.052). Our findings demonstrate that prophylactic LMV treatment is highly effective in preventing the development of csCMV infection and ultimately reduces transplant-related mortality.
Keyphrases
- risk factors
- end stage renal disease
- epstein barr virus
- cardiovascular events
- stem cell transplantation
- ejection fraction
- type diabetes
- peritoneal dialysis
- free survival
- clinical trial
- prognostic factors
- cell proliferation
- metabolic syndrome
- stem cells
- combination therapy
- insulin resistance
- electronic health record
- cell cycle arrest
- deep learning
- high dose
- cross sectional
- diffuse large b cell lymphoma
- smoking cessation
- skeletal muscle
- drug induced
- double blind