Efficacy of prophylactic letermovir for cytomegalovirus reactivation in hematopoietic cell transplantation: a multicenter real-world data
Efficacy of prophylactic letermovir for cytomegalovirus reactivation in hematopoietic cell transplantation: a multicenter real-world data
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DOI：
10.1038/s41409-020-01082-z
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发表时间：
2020-11-02
影响因子：
4.8
通讯作者：
Miyamoto, Toshihiro
中科院分区：
文献类型：
--
作者：
Mori, Yasuo;Jinnouchi, Fumiaki;Miyamoto, Toshihiro
一种新型的抗巨细胞病毒（CMV）药物莱特莫韦（LMV），据报道，可以改善异基因造血细胞移植（allo-HCT）受体的结果，因为它的高潜力，以防止CMV再激活。因此，回顾性分析了685例日本allo-HCT受者（其中80%的受者CMV再激活风险较高），以评估预防性LMV对临床显著CMV（csCMV）感染发生率及其移植结局的影响。通过比较114例接受中位92天LMV预防治疗的患者与571例未接受预防治疗的患者，我们观察到预防性LMV可显著（1）降低csCMV感染的180天累积发生率（44.7 vs. 72.4%，p < 0.001），（2）延迟至启动CMV抗原血症引导的抢先治疗的中位时间（90 vs.36天，p < 0.001），（3）缩短抗CMV优先治疗的持续时间（21天对25天，p = 0.006），和（4）提高移植后180天的总生存率（80.4 vs. 73.0%，p = 0.033），具有较低的非复发死亡率趋势（8.9 vs. 14.9%，p = 0.052）。我们的研究结果表明，预防性LMV治疗在预防csCMV感染的发展方面非常有效，并最终降低移植相关死亡率。
A novel anti-cytomegalovirus (CMV) agent, letermovir (LMV), could reportedly improve the outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) recipients because of its high potential to prevent CMV reactivation. Therefore, 685 Japanese allo-HCT recipients, of whom similar to 80% had a high risk of CMV reactivation, were retrospectively analyzed to assess the impacts of prophylactic LMV on the incidence of clinically significant CMV (csCMV) infection as well as their transplant outcome. By comparing 114 patients who received LMV prophylaxis for a median 92 days to 571 patients without prophylaxis, we observed that prophylactic LMV could significantly (1) reduce the 180-day cumulative incidence of csCMV infection (44.7 vs. 72.4%, p < 0.001), (2) delay the median time until initiation of CMV antigenemia-guided preemptive therapy (90 vs. 36 days, p < 0.001), (3) shorten the duration of anti-CMV preemptive treatment (21 vs. 25 days, p = 0.006), and (4) improve the overall survival rate at 180 days after transplant (80.4 vs. 73.0%, p = 0.033) with a trend of lower non-relapse mortality (8.9 vs. 14.9%, p = 0.052). Our findings demonstrate that prophylactic LMV treatment is highly effective in preventing the development of csCMV infection and ultimately reduces transplant-related mortality.