Risk factors for late cytomegalovirus infection after completing letermovir prophylaxis
Risk factors for late cytomegalovirus infection after completing letermovir prophylaxis
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DOI：
10.1007/s12185-022-03348-2
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发表时间：
2022-05-06
影响因子：
2.1
通讯作者：
Miyamoto, Toshihiro
中科院分区：
文献类型：
--
作者：
Mori, Yasuo;Harada, Takuya;Miyamoto, Toshihiro
预防性使用利特莫韦（LMV）可显著降低同种异体造血细胞移植（alloo - hct）后100天内早期临床显著巨细胞病毒（csCMV）感染的发生率，从而改善移植结果。然而，一些患者在完成LMV预防后最终发生晚期cscmv感染（超过100天）。为了评估晚期csCMV感染的发生率及其危险因素和对移植结果的影响，回顾性分析了81例在LMV预防期间未发生早期csCMV感染的同种异体hct受体。其中，23例（28.4%）患者分别在移植后131天和LMV停药后30天发生晚期cscmv感染（直至180天）。晚期cscmv感染与明显的延迟免疫重建相关：hla错配供者移植患者（风险比[HR] = 13.0, p = 0.011）或cmv - igg阴性供者移植患者（风险比[HR] = 2.39, p = 0.043）的风险明显更高。在这项研究中，移植结果在有和没有晚期cscmv感染的患者之间没有差异。这表明有必要澄清延长LMV治疗对大量同种异体hct受者，特别是那些“高风险”供者预防晚期cscmv感染的有效性。
Prophylactic use of letermovir (LMV) markedly reduces the incidence of early clinically significant cytomegalovirus (csCMV) infection within the first 100 days after allogeneic hematopoietic cell transplantation (allo-HCT), which improves transplant outcomes. However, some patients eventually develop late-csCMV infection (beyond day 100) after completing LMV prophylaxis. To assess the incidence of late-csCMV infection as well as its risk factors and impacts on transplant outcome, a total of 81 allo-HCT recipients who had not developed early csCMV infection during LMV prophylaxis were retrospectively analyzed. Among them, 23 (28.4%) patients developed late-csCMV infection (until day 180) at a median time of 131 days after transplantation and 30 days after LMV discontinuation, respectively. Late-csCMV infection was correlated with apparent delayed immune reconstitution: patients transplanted from HLA-mismatched donors (hazard ratio [HR] = 13.0, p = 0.011) or CMV-IgG-negative donors (HR = 2.39, p = 0.043) had a significantly higher risk. In this study, transplant outcomes did not differ between patients with and without late-csCMV infection. This suggests a need to clarify the efficacy of extended administration of LMV for preventing late-csCMV infection in a larger number of allo-HCT recipients, especially those with "high-risk" donors.