Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Blood Adv. 2024 Mar 12;8(5):1084-1093. doi: 10.1182/bloodadvances.2023010735.
Clinically significant cytomegalovirus infection (csCMVi) is frequently observed after allogeneic hematopoietic stem cell transplantation (HSCT) and prophylaxis with letermovir is commonly adopted. However, the clinical benefit of letermovir prophylaxis according to graft sources has not been sufficiently elucidated. We retrospectively analyzed 2194 recipients of HSCT who were CMV-seropositive (236 with letermovir prophylaxis and 1958 without prophylaxis against CMV). csCMVi was significantly less frequent in patients with letermovir prophylaxis than in those without (23.7% vs 58.7% at 100 days after HSCT, P < .001) and the same trend was seen when recipients of bone marrow (BM), peripheral blood stem cell (PBSC), or cord blood (CB) transplantation were separately analyzed. In recipients of BM, nonrelapse mortality (NRM) was significantly lower in the letermovir group at 6 months after HSCT (5.0% vs 14.9%, P = .018), and the same trend was observed in recipients of PBSCs (14.7% vs 24.8%, P = .062); however, there was no statistical significance at 1 year (BM, 21.1% vs 30.4%, P = .67; PBSCs, 21.2% vs 30.4%, P = .096). In contrast, NRM was comparable between recipients of CB with and without letermovir prophylaxis throughout the clinical course (6 months, 23.6% vs 24.3%, P =.92; 1 year, 29.3% vs 31.0%, P = .77), which was confirmed by multivariate analyses. In conclusion, the impact of letermovir prophylaxis on NRM and csCMVi should be separately considered according to graft sources.
异基因造血干细胞移植（HSCT）后常发生有临床意义的巨细胞病毒感染（csCMVi），通常采用来特莫韦预防。然而，根据移植物来源，来特莫韦预防的临床获益尚未得到充分阐明。我们回顾性分析了 2194 例 CMV 血清阳性的 HSCT 受者（来特莫韦预防组 236 例，无 CMV 预防组 1958 例）。与无来特莫韦预防组相比，来特莫韦预防组 csCMVi 的发生率显著降低（HSCT 后 100 天分别为 23.7%和 58.7%，P<.001），当分别分析骨髓（BM）、外周血干细胞（PBSC）或脐带血（CB）移植受者时，也呈现相同趋势。在 BM 移植受者中，来特莫韦组 HSCT 后 6 个月非复发死亡率（NRM）显著降低（5.0% vs 14.9%，P=.018），在 PBSC 移植受者中也观察到同样趋势（14.7% vs 24.8%，P=.062）；然而，在 1 年时无统计学意义（BM，21.1% vs 30.4%，P=.67；PBSC，21.2% vs 30.4%，P=.096）。相反，在整个临床过程中，CB 移植受者无论是否使用来特莫韦预防，NRM 均无差异（6 个月，23.6% vs 24.3%，P=.92；1 年，29.3% vs 31.0%，P= 0.77），多变量分析也证实了这一点。总之，来特莫韦预防对 NRM 和 csCMVi 的影响应根据移植物来源分别考虑。
