Clinical analysis of letermovir for preventing cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation
10.3760/cma.j.cn421203-20231030-00146
- VernacularTitle:新型非核苷类CMV抑制剂预防allo-HSCT后CMV再激活的临床分析
- Author:
Xianghan LIN
1
;
Suping ZHANG
;
Li LI
;
Zhilei BIAN
;
Siyu GAO
;
Jinpeng FAN
;
Yan LI
;
Dingming WAN
Author Information
1. 郑州大学第一附属医院血液科，郑州 450052
- Keywords:
Hematopoietic stem cell transplantation;
Allogeneic hematopoietic stem cell transplantation;
Cytomegalovirus
- From:
Chinese Journal of Organ Transplantation
2024;45(11):796-802
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the efficacy and safety of letermovir in preventing cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplantation (allo-HSCT) .Method:From September 2022 to September 2023, retrospective analysis was conducted for the relevant clinical data of 50 recipients of allo-HSCT at First Affiliated Hospital of Zhengzhou University Hospital. Letermovir prophylaxis was offered for preventing cytomegalovirus (CMV) reactivation post-transplantation. They were historically compared with previous patients at the same center without letermovir prophylaxis. The incidence of CMV reactivation, overall survival rate, engraftment status and other adverse events within 100 days post-transplant were compared between two groups. Propensity score matching (PSM) was utilized for controlling confounding factors. Univariate analyses were performed with t and chi-square tests while survival analysis conducted with Kaplan-Meier method.Result:In letermovir group, CMV reactivation was detected in 3 cases (6%) versus 23 cases (46%) in control group. Letermovir significantly reduced the incidence of post-transplant CMV reactivation ( P<0.01). Within Day 100 post-transplant, there was one death in letermovir group with an overall survival rate of 98%. In control group, three deaths occurred with an overall survival rate of 94%. The median survival time of deceased cases was 64 (58-81) day. No statistically significant inter-group difference existed in overall survival rate ( P=0.617). In letermovir group, secondary implantation failure was observed in 3 cases (6%) and it was lower than 12 cases (24%) in control group. Statistically significant inter-group difference existed in secondary implantation failure rate ( P=0.023). However, regarding timing of neutrophil engraftment ( P=0.054) and platelet engraftment ( P=0.649), there were no significant inter-group statistical differences. Hemorrhagic cystitis (HC) occurred in letermovir group (17 cses, 34%) and control group (27cases, 54%). The incidence of HC was significantly lower in letermovir group than that in control group ( P=0.044). However, no statistically significant inter-group difference existed in the incidence of post-transplant EBV infection or acute graft-versus-host disease. Conclusion:Letermovir may significantly lower the incidence of cytomegalovirus (CMV) reactivation after allo-HSCT. It is both effective and safe for preventing CMV disease and improving early outcomes.
