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Risk factors for late cytomegalovirus infection after completing letermovir prophylaxis

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Abstract

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.

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Acknowledgements

The authors would like to thank the medical and nursing staff who cared for the patients at the Kyushu University Hospital and provided patients information.

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Authors and Affiliations

  1. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yasuo Mori, Takuya Harada, Goichi Yoshimoto, Takahiro Shima, Akihiko Numata, Fumiaki Jinnouchi, Takuji Yamauchi, Yoshikane Kikushige, Yuya Kunisaki, Koji Kato, Katsuto Takenaka, Koichi Akashi & Toshihiro Miyamoto

  2. Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan

    Katsuto Takenaka

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  1. Yasuo Mori
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Correspondence to Toshihiro Miyamoto.

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K.A. and T.M. received honoraria from MSD Co., Ltd. The other authors have no conflicts of interests to declare.

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Mori, Y., Harada, T., Yoshimoto, G. et al. Risk factors for late cytomegalovirus infection after completing letermovir prophylaxis. Int J Hematol 116, 258–265 (2022). https://doi.org/10.1007/s12185-022-03348-2

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  • DOI: https://doi.org/10.1007/s12185-022-03348-2

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