Li Po-Hsien, Lin Cheng-Hsien, Lin Yu-Hui, Chen Tsung-Chih, Hsu Chiann-Yi, Teng Chieh-Lin Jerry
Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung.
Division of Infectious Diseases, Department of Medicine, Taichung Veterans General Hospital, Taichung.
Ther Adv Hematol. 2021 Mar 3;12:2040620721998124. doi: 10.1177/2040620721998124. eCollection 2021.
Letermovir prophylaxis is currently the standard of care for the prevention of cytomegalovirus (CMV) infections in allogeneic hematopoietic stem-cell transplantation (allo-HSCT). However, drug-drug interactions between letermovir and azoles or calcineurin inhibitors and the high financial burden of letermovir remain problematic, especially in resource-limited countries. It has not been clarified whether a lower dose of valganciclovir would constitute an effective strategy for CMV prevention in patients with acute leukemia undergoing allo-HSCT.
We retrospectively assessed 84 consecutive adult patients with acute leukemia who underwent allo-HSCT. These 84 patients were stratified into a valganciclovir prophylaxis group ( = 20) and a non-valganciclovir prophylaxis group ( = 64).
Patients in the valganciclovir prophylaxis group had a lower possibility of CMV DNAemia at week 14 after allo-HSCT than those in the non-valganciclovir prophylaxis group (15.0% 50.0%; = 0.012). The cumulative incidence of CMV DNAemia at week 14 was also lower in patients with valganciclovir CMV prophylaxis than in those without (15.0% 50.4%; = 0.006). Multivariate analysis validated these data, showing that a low dose of valganciclovir significantly reduced the risk of CMV DNAemia at week 14 by 88% (hazard ratio: 0.12; 95% confidence interval: 0.04-0.42; = 0.001). However, these two groups had similar overall survival rates at week 48 (75.0% 76.6%; = 0.805). Four of 20 (20%) patients discontinued valganciclovir prophylaxis because of adverse events.
Low-dose valganciclovir prophylaxis could be an alternative to letermovir to prevent CMV infection in allo-HSCT, especially in resource-limited countries.
来特莫韦预防目前是异基因造血干细胞移植（allo-HSCT）中预防巨细胞病毒（CMV）感染的标准治疗方法。然而，来特莫韦与唑类药物或钙调神经磷酸酶抑制剂之间的药物相互作用以及来特莫韦的高昂经济负担仍然存在问题，尤其是在资源有限的国家。对于接受allo-HSCT的急性白血病患者，较低剂量的缬更昔洛韦是否构成预防CMV的有效策略尚未明确。
我们回顾性评估了84例连续接受allo-HSCT的成年急性白血病患者。这84例患者被分为缬更昔洛韦预防组（n = 20）和非缬更昔洛韦预防组（n = 64）。
缬更昔洛韦预防组患者在allo-HSCT后第14周出现CMV血症的可能性低于非缬更昔洛韦预防组（15.0%对50.0%；P = 0.012）。缬更昔洛韦预防CMV的患者在第14周时CMV血症的累积发生率也低于未预防的患者（15.0%对50.4%；P = 0.006）。多变量分析验证了这些数据，表明低剂量的缬更昔洛韦在第14周时显著降低了CMV血症的风险88%（风险比：0.12；95%置信区间：0.04 - 0.42；P = 0.001）。然而，这两组在第48周时的总生存率相似（75.0%对76.6%；P = 0.805）。20例患者中有4例（20%）因不良事件停止了缬更昔洛韦预防。
低剂量缬更昔洛韦预防可作为来特莫韦的替代方法，用于预防allo-HSCT中的CMV感染，尤其是在资源有限的国家。
