Efficacy and safety of letermovir in preventing cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation
- VernacularTitle:来特莫韦预防异基因造血干细胞移植后巨细胞病毒感染的有效性与安全性分析
- Author:
Ranran WANG
1
,
2
;
Shuyue LI
1
,
3
;
Ranran LIANG
1
,
4
;
Xianmin SONG
5
;
Yuanjun TANG
1
;
Junwei GAO
1
Author Information
1. Dept. of Clinical Pharmacy，Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200080，China
2. Dept. of Clinical Pharmacy，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200092，China
3. Dept. of Pharmacy，Shanxi Cancer Hospital/Shanxi Hospital of Chinese Academy of Medical Sciences Cancer Hospital，Taiyuan 030013，China
4. Dept. of Pharmacy，the Second Affiliated Hospital of Shandong First Medical University，Shandong Taian 271000，China
5. Dept. of Hematology，Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200080，China
- Publication Type:Journal Article
- Keywords:
allogeneic hematopoietic stem cell transplantation;
cytomegalovirus infection;
letermovir;
prevention;
efficacy
- From:
China Pharmacy
2025;36(15):1904-1909
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the efficacy and safety of letermovir in preventing cytomegalovirus （CMV） infection after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. METHODS A retrospective cohort study was conducted， enrolling patients who underwent allo-HSCT at the Department of Hematology， Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine， from August 30， 2022， to February 21， 2024. Patients who initiated letermovir prophylaxis within 28 days post-transplantation were assigned to the experimental group （99 cases）， while those who did not initiate letermovir within this period were assigned to the control group （18 cases）. The incidence and clinical characteristics of CMV infection （including the number of wangranran@xinhuamed.com.cn CMV infection cases， the number of cases progressing to CMV disease， recurrent CMV disease， onset time of CMV infection， and treatment duration）， immune function recovery within 120 days post-transplantation， and the occurrence of transplantation-related complications （including CD4+ and CD8+ T-cell recovery， Epstein-Barr virus infection， acute graft-versus-host disease， human herpesvirus 6 infection， and posttransplant lymphoproliferative disorders） and adverse events were recorded. Univariate and multivariate Cox regression analyses were performed to identify factors influencing CMV infection. RESULTS A total of 117 patients were included， among whom 15 developed CMV infection， 5 progressed to CMV disease， and 2 experienced recurrent CMV disease. The CMV infection rate in the experimental group was significantly lower than that in the control group （P＜0.001）， and the onset time of CMV infection was significantly delayed （P＝0.014）. The proportion of patients with CD4+ T-cell counts ≥200 cells/μL in the experimental group was significantly lower than that in the control group （P＝0.022）. During the follow-up period， elevated creatinine levels were observed in 1 patient， and nausea and vomiting were observed in 2 patients. Multivariate Cox regression analysis revealed that the use of high-dose corticosteroids was a risk factor for CMV infection （HR＝6.230， 95%CI of 1.255-30.926， P＝0.025）， while initiating letermovir within 28 days post-transplantation was a protective factor （HR＝0.125， 95%CI of 0.045-0.348， P＜0.001）. CONCLUSIONS Early initiation of letermovir after allo-HSCT significantly reduces the CMV infection rate and delays the onset of infection， with favorable short-term safety.
