来特莫韦预防异基因造血细胞移植受者巨细胞病毒再激活：单中心加拿大数据。
Letermovir prophylaxis for cytomegalovirus reactivation in allogeneic hematopoietic cell transplant recipients: Single center Canadian data.
机构信息
Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Canada.
Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden.
出版信息
Eur J Haematol. 2024 Feb;112(2):301-309. doi: 10.1111/ejh.14117. Epub 2023 Oct 13.
BACKGROUND
Cytomegalovirus (CMV) is associated with morbidity and mortality following allogeneic hematopoietic cell transplantation (alloHCT). Letermovir is a novel antiviral agent that prevents CMV reactivation in alloHCT patients, with limited data regarding influence on post-alloHCT outcomes.
METHODS
We retrospectively examined 273 alloHCT recipients, 158 in the non-letermovir cohort (NLC), and 115 in the cohort using letermovir prophylaxis (LC). Patients that received letermovir were CMV-seropositive and met criteria for high risk of CMV reactivation.
RESULTS
Median start of letermovir was 21 days post-alloHCT, median duration of prophylaxis was 86 days. Letermovir prophylaxis demonstrated a statistically significant reduction in first CMV reactivation (at 200 days post 63.9% in the NLC vs. 35.7% in the LC; p < .001). On univariate analysis at 1 year, overall survival (OS) for NLC was 79.6% and 79.5% for LC (p = .54). Non relapse mortality (NRM) at 1 year for NLC was 12% and 12.3% for LC (p = .69). Cumulative incidence of relapse (CIR) at 1 year was 13.9% for NLC versus 17.1 for the LC (p = .27). On multivariable analysis, there was no significant difference between the two cohorts for OS, NRM, and CIR.
CONCLUSIONS
Letermovir prophylaxis started at day +21 post-alloHCT reduced CMV reactivation, with no impact on posttransplant outcomes.
背景
巨细胞病毒（CMV）与异基因造血细胞移植（alloHCT）后的发病率和死亡率有关。来特莫韦是一种新型抗病毒药物，可防止 alloHCT 患者的 CMV 再激活，关于其对 alloHCT 后结局的影响，数据有限。
方法
我们回顾性检查了 273 例 alloHCT 受者，其中 158 例在非来特莫韦组（NLC），115 例在使用来特莫韦预防组（LC）。接受来特莫韦的患者 CMV 血清阳性，符合 CMV 再激活高危标准。
结果
来特莫韦预防的中位起始时间为 alloHCT 后 21 天，预防的中位持续时间为 86 天。来特莫韦预防可显著降低首次 CMV 再激活（在 200 天，NLC 组为 63.9%，LC 组为 35.7%；p<0.001）。在单因素分析中，NLC 组在 1 年时的总生存率（OS）为 79.6%，LC 组为 79.5%（p=0.54）。NLC 组 1 年时非复发死亡率（NRM）为 12%，LC 组为 12.3%（p=0.69）。NLC 组在 1 年时的复发累积发生率（CIR）为 13.9%，LC 组为 17.1%（p=0.27）。多因素分析显示，两组在 OS、NRM 和 CIR 方面无显著差异。
结论
alloHCT 后第 21 天开始使用来特莫韦预防可降低 CMV 再激活，对移植后结局无影响。
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