Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Canada.
Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden.
Eur J Haematol. 2024 Feb;112(2):301-309. doi: 10.1111/ejh.14117. Epub 2023 Oct 13.
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.
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.
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.
Letermovir prophylaxis started at day +21 post-alloHCT reduced CMV reactivation, with no impact on posttransplant outcomes.
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。
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。
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。
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。
