Letermovir Prophylaxis Decreases Burden of Cytomegalovirus (CMV) in Patients at High Risk for CMV Disease Following Hematopoietic Cell Transplant
Letermovir Prophylaxis Decreases Burden of Cytomegalovirus (CMV) in Patients at High Risk for CMV Disease Following Hematopoietic Cell Transplant
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DOI：
10.1016/j.bbmt.2020.07.002
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发表时间：
2020-10-01
影响因子：
4.3
通讯作者：
Brown, Janice (Wes)
中科院分区：
文献类型：
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作者：
Johnsrud, Joyce J.;Nguyen, Isabelle T.;Brown, Janice (Wes)
尽管有有效的治疗方法，巨细胞病毒（CMV）继续对造血细胞移植受者的发病率和死亡率产生重大影响。特别危险的是接受替代移植物如脐带血（UCB）、单倍相合移植物（haplo）或接受T细胞耗竭方案如抗胸腺细胞球蛋白（ATG）的患者。随着莱特莫韦的批准，其对高风险患者的影响特别令人感兴趣。为了评估莱特莫韦预防在我们中心的影响，我们对2018年1月至2019年12月期间接受莱特莫韦预防（LET PPX）的114名高风险患者进行了回顾性分析，其中包括30名UCB和22名haplo接受者，与2013年1月至2019年12月期间具有可比风险的637名历史对照相比。到移植后第100天（D+100），与对照组相比，莱特莫韦预防显著降低了CMV DNA血症的发生率（45.37%对74.1%; P < .001）和临床显著CMV感染的发生率（12.04%对48.82%; P < .001）。LET PPX对有临床意义的CMV感染（CSI）发生率的影响更为深远，CSI定义为给予抗病毒治疗作为CMV DNA血症的抢先治疗或CMV疾病的治疗。LET PPX组单倍型受体的CSI显著低于对照组（13.64%对73.33%; P= 0.02），LET PPX组UCB受体的CSI显著低于对照组（3.45%对37.5%; P <0.001）。与对照组相比，在D+100时，任何治疗组中均无LET原发性PPX患者发生CMV疾病（分别为0%和5.34%; P = 0.006）。与对照组相比，LET PPX组患者开始抗CMV治疗的住院率更低（分别为0.93%和15.23%）。我们对迄今为止发表的CMV再激活高风险患者的最大队列的分析表明，莱特莫韦预防显著减少了因DNA血症或CMV引起的疾病而接受CMV活性抗病毒治疗的患者数量。(c)2020年美国移植和细胞治疗学会。爱思唯尔公司出版
Despite effective therapies, cytomegalovirus (CMV) continues to have a significant impact on morbidity and mortality in hematopoietic cell transplant recipients. At particular risk are recipients of alternative grafts such as umbilical cord blood (UCB), haploidentical transplants (haplo), or patients conditioned with T-cell depleting regimens such as anti-thymocyte globulin (ATG). With the approval of letermovir, its impact on high-risk patients is of particular interest. To evaluate the impact of letermovir prophylaxis at our center, we performed a retrospective analysis of 114 high-risk patients who received letermovir as prophylaxis (LET PPX) between January 2018 through December 2019, including 30 UCB and 22 haplo recipients, compared with 637 historical controls with comparable risk between January 2013 and December 2019. By post-transplant day 100 (D+100), letermovir prophylaxis significantly decreased the incidence of both CMV DNAemia compared with controls (45.37% versus 74.1%; P < .001) and clinically significant CMV infection (12.04% versus 48.82%; P < .001). The impact of LET PPX was even more profound on the incidence of clinically significant CMV infection (CSI), defined as the administration of antiviral therapy as preemptive therapy for CMV DNAemia or treatment for CMV disease. CSI was significantly lower in haplo recipients on LET PPX compared with controls (13.64% versus 73.33%; P=.02) and UCB recipients on LET PPX compared with controls (3.45% versus 37.5%; P < .001). No patients on LET primary PPX developed CMV disease in any treatment group by D+100 compared with controls (0% versus 5.34%, respectively; P =.006). Patients on LET PPX had fewer hospitalizations involving initiation of anti-CMV therapy compared with controls (0.93% versus 15.23%, respectively). Our analysis of the largest cohort of patients at high risk for CMV reactivation published to date demonstrates that letermovir prophylaxis significantly reduces the number of patients who receive CMV-active antiviral therapy for either DNAemia or disease due to CMV. (c) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.