Letermovir prophylaxis and risk of bacterial or fungal infection after allogeneic hematopoietic cell transplantation

IF 1.7 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2026-01-01 Epub Date: 2025-12-08 DOI:10.1016/j.jiac.2025.102888

Shun-ichi Kimura , Shunto Kawamura , Takashi Toya , Keiji Okinaka , Hiroki Hosoi , Naoyuki Uchida , Noriko Doki , Tetsuya Nishida , Masatsugu Tanaka , Yuta Hasegawa , Yoshinobu Kanda , Noboru Asada , Naoki Kurita , Hirohisa Nakamae , Tetsuya Eto , Makoto Yoshimitsu , Makoto Onizuka , Takahiro Fukuda , Marie Ohbiki , Yoshiko Atsuta , Kimikazu Yakushijin

{"title":"Letermovir prophylaxis and risk of bacterial or fungal infection after allogeneic hematopoietic cell transplantation","authors":"Shun-ichi Kimura , Shunto Kawamura , Takashi Toya , Keiji Okinaka , Hiroki Hosoi , Naoyuki Uchida , Noriko Doki , Tetsuya Nishida , Masatsugu Tanaka , Yuta Hasegawa , Yoshinobu Kanda , Noboru Asada , Naoki Kurita , Hirohisa Nakamae , Tetsuya Eto , Makoto Yoshimitsu , Makoto Onizuka , Takahiro Fukuda , Marie Ohbiki , Yoshiko Atsuta , Kimikazu Yakushijin","doi":"10.1016/j.jiac.2025.102888","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Previous reports have suggested an association between cytomegalovirus (CMV) infection and bacterial or fungal infections after allogeneic hematopoietic cell transplantation (HCT). This study aimed to examine the relationship between letermovir (LTV) prophylaxis and the incidence of bacteremia and invasive fungal infections.</div></div><div><h3>Methods</h3><div>Using a Japanese transplant registry database, we analyzed 19,531 patients who underwent their first allogeneic HCT from 2011 to 2022. Patients who initiated LTV prophylaxis within the first week post-transplantation were classified as the LTV group.</div></div><div><h3>Results</h3><div>A total of 4915 patients in the LTV group and 14,616 in the No LTV group were analyzed. The incidence of bacteremia by day 100 was significantly lower in the LTV group compared to the No LTV group (17.4 % vs. 21.7 %, <em>P</em> < 0.001). In the multivariate analysis, LTV prophylaxis (HR 0.75, 95 %CI: 0.69–0.81) was found to be significantly associated with a reduced risk of bacteremia, along with neutrophil engraftment. Age >50 years, male, non-remission status, alternative donors, higher values of the hematopoietic cell transplantation-comorbidity index, poor performance status, and grade II–IV acute graft-versus-host disease were associated with an increased risk of bacteremia. LTV was associated with a reduced risk of bacteremia both within 30 days (HR 0.74, 95 %CI: 0.68–0.81) and beyond 30 days (HR 0.76, 95 %CI: 0.66–0.89) after HCT. Conversely, it was not associated with the risk of invasive aspergillosis or candidemia.</div></div><div><h3>Conclusions</h3><div>LTV prophylaxis significantly reduced the risk of bacteremia. However, it was not associated with the risk of invasive fungal infections.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102888"},"PeriodicalIF":1.7000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1341321X25002867","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Previous reports have suggested an association between cytomegalovirus (CMV) infection and bacterial or fungal infections after allogeneic hematopoietic cell transplantation (HCT). This study aimed to examine the relationship between letermovir (LTV) prophylaxis and the incidence of bacteremia and invasive fungal infections.

Methods

Using a Japanese transplant registry database, we analyzed 19,531 patients who underwent their first allogeneic HCT from 2011 to 2022. Patients who initiated LTV prophylaxis within the first week post-transplantation were classified as the LTV group.

Results

A total of 4915 patients in the LTV group and 14,616 in the No LTV group were analyzed. The incidence of bacteremia by day 100 was significantly lower in the LTV group compared to the No LTV group (17.4 % vs. 21.7 %, P < 0.001). In the multivariate analysis, LTV prophylaxis (HR 0.75, 95 %CI: 0.69–0.81) was found to be significantly associated with a reduced risk of bacteremia, along with neutrophil engraftment. Age >50 years, male, non-remission status, alternative donors, higher values of the hematopoietic cell transplantation-comorbidity index, poor performance status, and grade II–IV acute graft-versus-host disease were associated with an increased risk of bacteremia. LTV was associated with a reduced risk of bacteremia both within 30 days (HR 0.74, 95 %CI: 0.68–0.81) and beyond 30 days (HR 0.76, 95 %CI: 0.66–0.89) after HCT. Conversely, it was not associated with the risk of invasive aspergillosis or candidemia.

Conclusions

LTV prophylaxis significantly reduced the risk of bacteremia. However, it was not associated with the risk of invasive fungal infections.

查看原文本刊更多论文

莱特莫韦预防异基因造血细胞移植后细菌或真菌感染的风险。

背景：先前的报道表明，同种异体造血细胞移植（HCT）后巨细胞病毒（CMV）感染与细菌或真菌感染之间存在关联。本研究旨在探讨利特莫韦（LTV）预防与菌血症和侵袭性真菌感染的关系。方法：使用日本移植登记数据库，我们分析了2011年至2022年首次接受同种异体HCT的19531例患者。移植后第一周内开始LTV预防的患者被归类为LTV组。结果：LTV组共4915例，无LTV组共14616例。与无LTV组相比，LTV组第100天的菌血症发生率显著降低（17.4%比21.7%,P < 0.001）。在多变量分析中，发现LTV预防（HR 0.75, 95%CI: 0.69 - 0.81）与降低菌血症风险以及中性粒细胞植入显著相关。年龄bb - 50岁，男性，非缓解状态，替代供体，较高的造血细胞移植合并症指数，较差的状态和II-IV级急性移植物抗宿主病与菌血症的风险增加相关。LTV与HCT后30天内（HR 0.74, 95%CI: 0.68-0.81）和30天后（HR 0.76, 95%CI: 0.66-0.89）菌血症风险降低相关。相反，它与侵袭性曲霉病或念珠菌病的风险无关。结论：LTV预防可显著降低菌血症的发生风险。然而，它与侵袭性真菌感染的风险无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

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.