Impact of letermovir primary cytomegalovirus prophylaxis on 1-year mortality after allogeneic hematopoietic cell transplantation: A retrospective cohort study Journal Article
| Authors: | Su, Y.; Stern, A.; Karantoni, E.; Nawar, T.; Han, G.; Zavras, P.; Dumke, H.; Cho, C.; Tamari, R.; Shaffer, B.; Giralt, S.; Jakubowski, A.; Perales, M. A.; Papanicolaou, G. |
| Article Title: | Impact of letermovir primary cytomegalovirus prophylaxis on 1-year mortality after allogeneic hematopoietic cell transplantation: A retrospective cohort study |
| Abstract: | BACKGROUND: Cytomegalovirus (CMV)-seropositive (R+) hematopoietic cell transplant (HCT) recipients have a survival disparity compared with CMV-seronegative recipient/donor (R-D-) pairs. We hypothesized that primary letermovir prophylaxis (LET) may abrogate this disparity. We investigated the relationship between LET and mortality at 1 year post-HCT. METHODS: In this retrospective cohort study, we included adult R-D- or R+ patients who received HCT pre-LET (between 1 January 2013 through 15 December 2017) and post-LET (between 16 December 2017 through December 2019). R+ were categorized by LET receipt as R+/LET or R+/no-LET. Cox proportional hazard models were used to estimate the association of LET with all-cause mortality at 1 year after transplantation. RESULTS: Of 848 patients analyzed, 305 were R-D-, 364 R+/no-LET, and 160 R+/LET. Because of similar mortality (adjusted hazard ratio [aHR], 1.29 [95% confidence interval {CI}, .76-2.18]; P = .353]) between pre-LET/R-D- and post-LET/R-D-, R-D- were combined into 1 group. Compared with R-D-, the aHR for mortality was 1.40 (95% CI, 1.01-1.93) for R+/no-LET and 0.89 (95% CI, .57-1.41) for R+/LET. Among R+, LET was associated with decreased risk of death (aHR, 0.62 [95% CI, .40-.98]); when conventional HCT and T-cell depleted HCT were analyzed separately, the aHR was 0.86 (95% CI, .51-1.43) and 0.21 (95% CI, .07-.65), respectively. CONCLUSIONS: At 1 year post-HCT, LET was associated with closing the mortality disparity between R-D- and R+. Among all R+, LET was associated with decreased mortality, driven by 79% reduced incidence of death in T-cell depleted HCT. © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. |
| Keywords: | adult; retrospective studies; mortality; hematopoietic stem cell transplantation; retrospective study; antivirus agent; quinazolines; acetic acid; cytomegalovirus infection; quinazoline derivative; cytomegalovirus; antiviral agents; prevention; adverse event; hct; cmv; cytomegalovirus infections; acetates; humans; human; letermovir; allogeneic hematopoietic cell transplant |
| Journal Title: | Clinical Infectious Diseases |
| Volume: | 75 |
| Issue: | 5 |
| ISSN: | 1058-4838 |
| Publisher: | Oxford University Press |
| Date Published: | 2022-09-01 |
| Start Page: | 795 |
| End Page: | 804 |
| Language: | English |
| DOI: | 10.1093/cid/ciab1064 |
| PUBMED: | 34979021 |
| PROVIDER: | scopus |
| PMCID: | PMC9477449 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work