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Cytomegalovirus Prophylaxis With Letermovir in Pediatric, Adolescent, and Young-Adult Patients Undergoing Hematopoietic Stem-Cell Transplant.

Authors :
Dietz, Marleigh
Chakravarthy, Rohini
Rogozinski, Lindsay
Ho, Richard
Kitko, Carrie
Gulley, Savannah
Source :
Journal of Hematology Oncology Pharmacy. Aug2024, Vol. 14 Issue 4, p133-138. 6p.
Publication Year :
2024

Abstract

BACKGROUND: Cytomegalovirus (CMV) reactivation occurs in up to 70% of CMV-seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) and carries a high rate of morbidity and mortality. Ganciclovir and foscarnet have been used for the prevention of CMV; however, both drugs have undesirable adverse events (AEs). In 2017, letermovir was approved for CMV prophylaxis in adults, but data in the pediatric and adolescent and young adult (AYA) populations are limited. OBJECTIVE: To evaluate the efficacy and safety of letermovir for CMV prophylaxis in pediatric and AYA populations. METHODS: This retrospective chart review assessed patients who had HSCT and received letermovir for CMV prophylaxis at Monroe Carell Jr Children’s Hospital at Vanderbilt between January 1, 2017, and December 31, 2021. The patients were eligible for letermovir prophylaxis if they met the following criteria: they were a donor or recipient with CMV seropositivity, were aged >12 years, weighed >35 kg, and had outpatient insurance approval for treatment with letermovir. The dose and length of letermovir treatment were recorded. Patient response was determined by CMV reactivation occurrences. The AEs that were related to letermovir treatment were also evaluated. RESULTS: A total of 11 patients were evaluated, with a median transplant age of 18 years (range, 14-28 years) and a median weight of 76.5 kg (range, 48.2-130.4 kg). Of these 11 patients, 10 received letermovir 480 mg daily, and 1 patient received 240 mg daily. Two (18.2%) patients had CMV reactivation that required intervention, both of which occurred at least 1 month after the discontinuation of letermovir treatment, whereas 9 (81.8%) patients did not have CMV reactivation that required intervention. The AEs that were associated with letermovir treatment were mild: 27.3% of patients had cough, 18.2% each had headaches and myalgia, and 9.1% each had tachycardia, edema, and dyspnea. Of the total patients, 72.7% had nausea and vomiting and 63.6% had diarrhea; however, these AEs are unlikely to be directly related to treatment with letermovir and are as a result of other explainable causes. CONCLUSION: Based on the high prevention rate of CMV reactivation in the pediatric and AYA patients and the tolerable AEs observed within these cohorts, letermovir prophylaxis is a reasonable treatment option for pediatric and AYA patients. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
21641153
Volume :
14
Issue :
4
Database :
Academic Search Index
Journal :
Journal of Hematology Oncology Pharmacy
Publication Type :
Academic Journal
Accession number :
179095498