Extended-duration letermovir prophylaxis for cytomegalovirus infection after cord blood transplantation in adults Journal Article
| Authors: | Politikos, I.; Lau, C.; Devlin, S. M.; Quach, S.; Lin, A.; Perales, M. A.; Shah, G. L.; Seo, S. K.; Papanicolaou, G. A.; Barker, J. N. |
| Article Title: | Extended-duration letermovir prophylaxis for cytomegalovirus infection after cord blood transplantation in adults |
| Abstract: | Cord blood transplantation (CBT) can be complicated by a high incidence of clinically significant cytomegalovirus infection (csCMVi). We have investigated the efficacy of extended letermovir prophylaxis in seropositive adult CBT recipients. The aim was to continue prophylaxis for ≥6 months (insurance permitting). By day 100, the incidence of csCMVi was 0% in 28 patients who received letermovir prophylaxis. Moreover, of 24 patients alive at day 100, none had csCMVi by day 180, having continued prophylaxis for all (n = 20) or part (n = 4) of that period. Overall, 20 patients stopped letermovir at a median of 354 days (range, 119-455 days) posttransplant, with only 5 requiring 1 (n = 4) or 2 (n = 1) courses of valganciclovir (median total duration, 58 days; range, 12-67 days) for postprophylaxis viremia, with no subsequent csCMVi. There were no toxicities attributable to letermovir. Of the 62 historic control subjects who received acyclovir only, 51 developed csCMVi (median onset, 34 days; range, 5-74 days), for a day 100 incidence of 82% (95% confidence interval, 73-92). Seven patients developed proven/probable CMV disease, and 6 died before day 100 (3 with proven/probable CMV pneumonia). Forty-five patients required extended therapy during the first 6 months for 1 (n = 10), 2 (n = 14), or 3/persistent (n = 21) csCMVi, with 43 (84%) of 51 developing significant treatment toxicities. Letermovir is a highly effective, well-tolerated prophylaxis that mitigates CMV infection, CMV-related mortality, and antiviral therapy toxicities in CBT recipients. Our data support prophylaxis duration of at least 6 months after CBT. © 2022 by The American Society of Hematology. |
| Keywords: | adult; clinical article; controlled study; aged; middle aged; survival rate; young adult; overall survival; myeloproliferative disorder; fludarabine; drug tolerability; mortality; neutropenia; drug efficacy; drug withdrawal; treatment duration; progression free survival; nephrotoxicity; incidence; aciclovir; cyclophosphamide; chronic myeloid leukemia; retrospective study; thiotepa; acute lymphoblastic leukemia; health insurance; cord blood stem cell transplantation; myelodysplastic syndrome; nonhodgkin lymphoma; whole body radiation; prophylaxis; graft versus host reaction; real time polymerase chain reaction; virus load; graft rejection; infection prevention; drug dose increase; granulocyte colony stimulating factor; foscarnet; ganciclovir; cytomegalovirus infection; cyclosporine; cytomegalovirus; valganciclovir; acute myeloid leukemia; tocilizumab; mycophenolate mofetil; human; male; female; article; letermovir |
| Journal Title: | Blood Advances |
| Volume: | 6 |
| Issue: | 24 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2022-12-27 |
| Start Page: | 6291 |
| End Page: | 6300 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2022008047 |
| PUBMED: | 35802462 |
| PROVIDER: | scopus |
| PMCID: | PMC9806329 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding author is MSK author Ioannis Politikos -- Export Date: 1 March 2023 -- Source: Scopus |
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