Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

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

Dukhee Nho
ORCID logo ,
Raeseok Lee
ORCID logo ,
Sung-Yeon Cho
* ORCID logo ,
Dong-Gun Lee
ORCID logo ,
Eun-Jin Kim
,
Silvia Park
,
Sung-Eun Lee
ORCID logo ,
Byung-Sik Cho
ORCID logo ,
Yoo-Jin Kim
,
Seok Lee
,
Hee-Je Kim
ORCID logo
Version 1 : Received: 14 August 2023 / Approved: 14 August 2023 / Online: 15 August 2023 (09:28:45 CEST)

A peer-reviewed article of this Preprint also exists.

Nho, D.; Lee, R.; Cho, S.-Y.; Lee, D.-G.; Kim, E.-J.; Park, S.; Lee, S.-E.; Cho, B.-S.; Kim, Y.-J.; Lee, S.; Kim, H.-J. Cytomegalovirus Infection after Allogeneic Hematopoietic Cell Transplantation under 100-Day Letermovir Prophylaxis: A Real-World 1-Year Follow-Up Study. Viruses 2023, 15, 1884. Nho, D.; Lee, R.; Cho, S.-Y.; Lee, D.-G.; Kim, E.-J.; Park, S.; Lee, S.-E.; Cho, B.-S.; Kim, Y.-J.; Lee, S.; Kim, H.-J. Cytomegalovirus Infection after Allogeneic Hematopoietic Cell Transplantation under 100-Day Letermovir Prophylaxis: A Real-World 1-Year Follow-Up Study. Viruses 2023, 15, 1884.

Abstract

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.

Keywords

Cytomegalovirus; prophylaxis; allogeneic hematopoietic cell transplantation; real-world data

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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