Effectiveness of letermovir in preventing cytomegalovirus reactivation after cord blood transplantation.

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-02-01 Epub Date: 2024-12-03 DOI:10.1016/j.jiac.2024.12.002

Naoki Okada, Hiroyuki Muranushi, Kazuya Okada, Takayuki Sato, Tatsuhito Onishi, Yasunori Ueda, Takeshi Maeda

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引用次数: 0

Abstract

Background: Cord blood transplantation (CBT) is associated with a high risk of cytomegalovirus (CMV) infection. Letermovir (LTV) is a prophylactic agent against CMV reactivation after CBT, but data on its effectiveness and the incidence of late CMV reactivation after LTV discontinuation are limited.

Methods: A single-center retrospective observational study was conducted in 79 adult CMV-seropositive CBT recipients who received their first transplant for acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome from February 2016 to September 2022. Outcomes were compared between 45 patients who received LTV prophylaxis and 34 patients who did not.

Results: The cumulative incidence of CMV reactivation was significantly lower in patients who received LTV prophylaxis at both day 100 (11.1 % vs. 82.4 %, p < 0.001) and 1 year (45.3 % vs. 82.4 %, p < 0.001). The incidence of late CMV reactivation after LTV discontinuation was 34.2 %. The cumulative incidence of CMV disease was comparable between patients who received and those who did not (0 % vs. 8.8 % at day 100, 2.3 % vs. 8.8 % at 1 year; p = 0.181). Multivariate analysis showed that LTV prophylaxis reduced the cumulative incidence of CMV reactivation (hazard ratio 0.20, 95 % confidence interval 0.09 to 0.42, p < 0.001).

Conclusion: LTV prophylaxis is strongly associated with prevention of CMV reactivation after CBT. Due to the high incidence of late CMV reactivation, close monitoring is required after LTV discontinuation and extension of LTV prophylaxis beyond day 100 should be considered.

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利特莫韦预防脐带血移植后巨细胞病毒再激活的疗效。

背景：脐带血移植（CBT）与巨细胞病毒（CMV）感染的高风险相关。Letermovir （LTV）是一种预防CBT后CMV再激活的药物，但关于其有效性和LTV停药后晚期CMV再激活发生率的数据有限。方法：2016年2月至2022年9月，对79例成人cmv血清阳性CBT患者进行了单中心回顾性观察研究，这些患者因急性髓性白血病、急性淋巴细胞白血病或骨髓增生异常综合征接受了首次移植。结果比较了45例接受LTV预防的患者和34例未接受LTV预防的患者。结果：接受LTV预防的患者在第100天（11.1% vs. 82.4%, p < 0.001）和第1年（45.3% vs. 82.4%, p < 0.001） CMV再激活的累积发生率均显著降低。LTV停药后晚期CMV再激活的发生率为34.2%。CMV疾病的累积发病率在接受治疗和未接受治疗的患者之间具有可比性(第100天0%对8.8%，1年2.3%对8.8%；P = 0.181)。多因素分析显示，预防LTV可降低CMV再激活的累积发生率（风险比0.20,95%可信区间0.09 ~ 0.42,p < 0.001）。结论：LTV预防与CBT后CMV再激活的预防密切相关。由于晚期巨细胞病毒再激活的发生率很高，在LTV停止后需要密切监测，并应考虑将LTV预防延长至100天以上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.