Authors: | Han, G.; Stern, A.; Lee, Y. J.; Li, Y.; Dahi, P. B.; Tamari, R.; Gyurkocza, B.; Jakubowski, A. A.; Papadopoulos, E. B.; Shaffer, B.; Perales, M. A.; Obeid, K. M.; Young, J. A. H.; Papanicolaou, G. A. |
Article Title: | Letermovir for prevention of recurrent cytomegalovirus in high-risk allogeneic hematopoietic cell transplantation recipients |
Abstract: | We evaluated letermovir (LTV) for secondary prophylaxis for cytomegalovirus (CMV) in allogeneic hematopoietic cell transplant recipients (HCT) at high-risk for CMV recurrence. This open-label study was conducted at Memorial Sloan Kettering Cancer Center and the University of Minnesota. Patients with clinically significant CMV infection (cs-CMVi) and ≥1 high-risk criteria for CMV who achieved viral suppression with standard CMV antivirals received LTV secondary prophylaxis for up to 14 weeks. The primary endpoint was cs-CMVi at week 14; secondary endpoints included LTV resistance, CMV end-organ disease (EOD), CMV-related death, and LTV-related adverse events at week 14. Thirty-six patients were analyzed (CMV seropositive, n = 33; T cell-depleted HCT, n = 25; cord blood allograft, n = 5). By week 14 post-transplantation, 5 patients met the primary endpoint of cs-CMVi, for a cumulative incidence of 14.9% (95% confidence interval, 2.6% to 27.1%). Four patients developed LTV breakthrough cs-CMVi (including 2 patients with confirmed LTV resistance). The remaining patient developed rebound cs-CMVi after premature discontinuation of LTV due to enrollment in a clinical trial. There were no cases of CMV EOD, CMV-related death, or LTV-related adverse events by week 14 or by week 24. Our data support that LTV secondary prophylaxis is safe and effective in high-risk HCT recipients. © 2024 The American Society for Transplantation and Cellular Therapy |
Keywords: | adult; clinical article; controlled study; aged; middle aged; transplantation, homologous; young adult; clinical trial; side effect; risk factors; recurrence; hematopoietic stem cell transplantation; drug effect; risk factor; drug combination; prophylaxis; hematopoietic cell; recurrent disease; allogeneic hematopoietic stem cell transplantation; umbilical cord blood; open study; antivirus agent; drug dose; prematurity; quinazolines; acetic acid; cytomegalovirus infection; therapy; quinazoline derivative; cytomegalovirus; graft recipient; alemtuzumab; allotransplantation; cell transplantation; antiviral activity; prevention and control; oral drug administration; antiviral agents; prevention; hematopoietic cell transplantation; adverse event; cytomegalovirus infections; acetates; very elderly; humans; human; male; female; article; secondary prophylaxis; letermovir; cmv recurrence |
Journal Title: | Transplantation and Cellular Therapy |
Volume: | 31 |
Issue: | 2 |
ISSN: | 2666-6375 |
Publisher: | Elsevier Inc. |
Date Published: | 2025-02-01 |
Start Page: | 105.e1 |
End Page: | 105.e9 |
Language: | English |
DOI: | 10.1016/j.jtct.2024.12.010 |
PUBMED: | 39701288 |
PROVIDER: | scopus |
PMCID: | PMC11936460 |
DOI/URL: | |
Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Genovefa Papanicolaou -- Source: Scopus |