Cytomegalovirus Infection after Allogeneic Hematopoietic Cell Transplantation under 100-day Letermovir Prophylaxis: a Real-world, 1-year Follow-up Study

• DOI: 10.20944/preprints202308.1087.v1
• Publication Date: 2023-08-16T00:52:25Z
• Authors: Dukhee Nho; Raeseok Lee; Sung-Yeon Cho; Dong-Gun Lee; Eun-Jin Kim; Silvia Park; Sung-Eun Lee; Byung-Sik Cho; Yoo-Jin Kim; Seok Lee; Hee-Je Kim
• Keywords: allogeneic hematopoietic cell transplantation; real-world data; Hematopoietic Stem Cell Transplantation; Graft vs Host Disease; Microbiology; QR1-502; Article; 3. Good health; Cytomegalovirus Infections; Humans; prophylaxis; cytomegalovirus; Follow-Up Studies; Retrospective Studies

Prevention and management of cytomegalovirus (CMV) reactivation is important to improve outcome of allogeneic hematopoietic cell transplantation (allo-HCT) recipients. The aim of this study was to analyze real-world data for incidence and characteristics of CMV infections until 1-year after allo-HCT under 100-day letermovir prophylaxis. A single-center retrospective study was conducted between November 2020 and October 2021. During the study period, 358 patients underwent allo-HCT, 306 of whom received letermovir prophylaxis. Cumulative incidence of clinically significant CMV infection (CS-CMVi) was 11.4%, 31.7%, and 36.9% at 14-weeks, 24-weeks, and 1-year post-HCT, respectively. In multivariate analysis, risk of CS-CMVi increased with graft-versus-host disease (GVHD) ≥ grade 2 (adjusted odds ratio 3.640 [2.036–6.510]; P < 0.001). One-year non-relapse mortality was significantly higher in letermovir breakthrough CS-CMVi patients than those with subclinical CMV reactivation who continued letermovir (P = 0.002). There were 18 (15.9%) refractory CMV infection in this study population. In summary, letermovir prophylaxis is effective in preventing CS-CMVi until day 100, which increased after cessation of letermovir. GVHD is still a significant risk factor in letermovir prophylaxis era. Further research is needed to establish individualized management strategies especially in patients with significant GVHD or letermovir breakthrough CS-CMVi.