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. 2024 Jan;103(1):285-296.
doi: 10.1007/s00277-023-05474-1. Epub 2023 Nov 10.

Outcomes of allogeneic hematopoietic cell transplantation under letermovir prophylaxis for cytomegalovirus infection

Katsuto Takenaka  1 , Shigeo Fuji  2 , Toshihiro Matsukawa  3 , Naoyuki Uchida  4 , Takeshi Kobayashi  5 , Masatsugu Tanaka  6 , Takahide Ara  3 , Kazuhiro Ikegame  7 , Yukiyasu Ozawa  8 , Yoshinobu Kanda  9 , Masashi Sawa  10 , Yumiko Maruyama  11 , Takahiro Fukuda  12 , Hirohisa Nakamae  13 , Takafumi Kimura  14 , Masao Ogata  15 , Sachiko Seo  16 , Yoshiko Atsuta  17   18 , Keitaro Matsuo  19 , Hideki Nakasone  9
Affiliations

Outcomes of allogeneic hematopoietic cell transplantation under letermovir prophylaxis for cytomegalovirus infection

Katsuto Takenaka et al. Ann Hematol. 2024 Jan.

Abstract

Cytomegalovirus (CMV) infection is a major infectious complication following allogeneic hematopoietic cell transplantation (allo-HCT). Although letermovir (LMV) prophylaxis dramatically reduces the incidence of early clinically significant CMV (csCMV) infection, it remains unclear whether it has a beneficial effect on nonrelapse mortality (NRM) and overall survival (OS). Herein, we evaluated the impact of LMV prophylaxis on posttransplant outcomes using the registry database of the Japanese Society for Transplantation and Cellular Therapy. Adult patients who underwent allo-HCT between 2017 and 2019 were analyzed (n = 6004). LMV prophylaxis was administered to 1640 patients (LMV group) and it significantly reduced the incidence of csCMV infection compared with those not administered LMV prophylaxis (15.4% vs 54.1%; p < 0.01). However, it did not improve the 1-year NRM (hazard ratio [HR], 0.93; p = 0.40) and OS (HR, 0.96; p = 0.49). In the LMV group, 74 patients had breakthrough csCMV infection and showed inferior NRM (HR, 3.44; p < 0.01) and OS (HR, 1.93; p = 0.02) compared with those without infection. After completing LMV prophylaxis, 252 patients had late csCMV infection and showed inferior NRM (HR, 1.83; p < 0.01) and OS (HR, 1.58; p < 0.01). Our findings suggest that managing breakthrough and late csCMV infections is important for improving long-term outcomes.

Keywords: Allogeneic hematopoietic cell transplantation; Cytomegalovirus; Letermovir; Nonrelapse mortality; Prophylaxis.

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