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Letermovir for Prevention of Cytomegalovirus Reactivation in Haploidentical and Mismatched Adult Donor Allogeneic Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide for Graft-versus-Host Disease Prophylaxis
- Source :
- Transplant Cell Ther
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Cytomegalovirus (CMV) is serious viral infection in allogeneic hematopoietic cell transplantation (allo-HCT) recipients. November 2017, the novel CMV DNA terminase complex inhibitor letermovir was approved for prophylaxis of CMV infection in CMV-seropositive allo-HCT recipients. Here we sought to determine the effectiveness of letermovir in preventing CMV infection in CMV-seropositive patients undergoing haploidentical or mismatched adult unrelated donor allo-HCT using post-transplantation cyclophosphamide-based graft-versus host-disease prophylaxis. Sixty-four patients underwent transplantation between 2014 and 2019, of whom 32 received letermovir and 32 did not receive letermovir. The day 180 cumulative incidence of CMV infection requiring therapy was 45.3% (95% confidence interval [CI], 32.7% to 57.1%) in the entire cohort, 68.8% (95% CI, 48.9% to 82.2%) in the patients who did not receive letermovir, and 21.9% (95% CI, 9.5% to 37.6%; P.001) in patients who received letermovir. Adjusting for regimen intensity, disease histology, and age, the hazard ratio for CMV infection was .19 (95% CI, .08 to .47; P.001) in patients who received primary prophylaxis with letermovir. The 1-year cumulative incidence of treatment- related mortality was similar between patients with and without letermovir treatment (16.9% versus 18.9%), as was overall survival (64.0% versus 49.0%). Persistent CMV infection requiring28 days of therapy was more common in patients who did not receive letermovir (31.2% versus 6.2%; P = .02). In summary, letermovir was effective in preventing CMV infection in this high-risk population of HLA-mismatched allo-HCT recipients.
- Subjects :
- Adult
medicine.medical_specialty
Cyclophosphamide
Population
Congenital cytomegalovirus infection
Cytomegalovirus
Graft vs Host Disease
Acetates
Article
03 medical and health sciences
Letermovir
0302 clinical medicine
Internal medicine
medicine
Humans
Immunology and Allergy
Cumulative incidence
education
Transplantation
education.field_of_study
business.industry
Hematopoietic Stem Cell Transplantation
virus diseases
Cell Biology
Hematology
medicine.disease
Graft-versus-host disease
030220 oncology & carcinogenesis
Cohort
Quinazolines
Molecular Medicine
business
030215 immunology
medicine.drug
Subjects
Details
- ISSN :
- 26666367
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- Transplantation and Cellular Therapy
- Accession number :
- edsair.doi.dedup.....269fea8c0ed5fb60df7371678d704197