Mendoza Maria Alejandra, Bhaimia Eric, Alkhateeb Hassan B, Razonable Raymund R, Thoendel Matthew
Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Transpl Infect Dis. 2024 Dec;26(6):e14377. doi: 10.1111/tid.14377. Epub 2024 Sep 28.
Cytomegalovirus (CMV) reactivation is one of the most common complications after allogeneic hematopoietic stem cell transplantation (HSCT). Letermovir is approved for CMV prophylaxis among high-risk recipients. However, delayed-onset post-prophylaxis clinically significant CMV infection (csCMVi) has been observed, suggesting the potential for extending letermovir prophylaxis beyond the first one hundred days post-HSCT.
Retrospective multicenter cohort study of allogeneic HSCT patients from August 2018 to March 2023. The primary aim of this study was to identify the risk factors at day 100 associated with delayed onset csCMVi, in patients who received letermovir prophylaxis up to day 100. Competing risk analysis was used to evaluate incidence with specific risk factors, using Gray's Test comparing groups for each event.
Among 166 eligible allogeneic HSCT recipients, the most common primary hematological diagnosis was acute myelogenous leukemia (AML) (42.2%). Twenty-six (15.7%) developed a breakthrough csCMVi. Delayed-onset csCMVi occurred in 23.5%, at a median time of 133 days after SCT. On multivariate analysis, having a matched unrelated donor (odds ratio [OR] 2.46) and a CMV donor negative/recipient positive status (OR 3.47) were associated with delayed onset csCMVi. In contrast, AML had a lower odd of having delayed-onset csCMVi (OR 0.23).
Having a matched unrelated donor, a CMV donor negative/recipient positive status, and a non-AML underlying disease were associated with delayed onset csCMVi. Prospective studies are needed to evaluate whether extended letermovir prophylaxis is beneficial for these patients.
巨细胞病毒（CMV）再激活是异基因造血干细胞移植（HSCT）后最常见的并发症之一。来特莫韦已被批准用于高危受者的CMV预防。然而，已观察到预防后延迟发生的具有临床意义的CMV感染（csCMVi），这表明来特莫韦预防可能需要在HSCT后100天以上继续进行。
对2018年8月至2023年3月期间接受异基因HSCT的患者进行回顾性多中心队列研究。本研究的主要目的是确定在接受来特莫韦预防至第100天的患者中，与延迟发生csCMVi相关的第100天的危险因素。采用竞争风险分析评估特定危险因素的发生率，使用Gray检验比较各事件组。
在166例符合条件的异基因HSCT受者中，最常见的原发性血液学诊断为急性髓系白血病（AML）（42.2%）。26例（15.7%）发生突破性csCMVi。延迟发生csCMVi的发生率为23.5%，中位时间为SCT后133天。多因素分析显示，接受匹配无关供者（比值比[OR]2.46）和CMV供者阴性/受者阳性状态（OR 3.47）与延迟发生csCMVi相关。相比之下，AML患者发生延迟性csCMVi的几率较低（OR 0.23）。
接受匹配无关供者、CMV供者阴性/受者阳性状态以及非AML基础疾病与延迟发生csCMVi相关。需要进行前瞻性研究以评估延长来特莫韦预防对这些患者是否有益。
