open access

Vol 53, No 5 (2022)
Original research article
Submitted: 2022-06-25
Accepted: 2022-08-21
Published online: 2022-10-02
Get Citation

Real-life experiences of letermovir prophylaxis for cytomegalovirus infection in patients after hematopoietic stem cell transplantation: Polish Acute Leukemia Group (PALG) analysis

Anna Łojko1, Jan Styczyński2, Barbara Nasiłowska-Adamska3, Joanna Mańko3, Krzysztof Kałwak4, Patrycja Mensah-Glanowska5, Jarosław Dybko6, Maciej Majcherek7, Anna Czyż7, Agnieszka Pluta8, Lidia Gil1
DOI: 10.5603/AHP.a2022.2047
·
Acta Haematol Pol 2022;53(5):350-354.
Affiliations
  1. Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
  2. Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
  3. Department of Hematology, Institute od Hematology and Transfusion Medicine in Warsaw, Warszawa, Poland
  4. Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wrocław, Poland
  5. Department of Hematology, Collegium Medicum, Jagiellonian University, Kraków, Poland
  6. Department of Hematology and Transplantology, Lower Silesian Oncology Center, Wrocław, Poland
  7. Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
  8. Department of Hematology, Medical University in Lodz, Łódż, Poland

open access

Vol 53, No 5 (2022)
ORIGINAL RESEARCH ARTICLE
Submitted: 2022-06-25
Accepted: 2022-08-21
Published online: 2022-10-02

Abstract

Introduction: Letermovir (LMV) is a new, cytomegalovirus (CMV)-specific, antiviral drug, approved in 2018 for CMV prophylaxis in patients after allogeneic hematopoietic transplantation. The introduction of letermovir prophylaxis has changed the management of CMV infection: it has reduced the incidence of CMV infections and CMV-related complications, and also improved the overall survival in CMV seropositive patients. However, until recently, due to its high treatment cost, prophylaxis with letermovir has not beeen a standard of care in Poland. Material and methods: To confirm the effectiveness and safety of letermovir prophylaxis, we collected real-life data from eight Polish transplant centers, in which a total of 53 patients were treated with letermovir, including off-label use. Results: LMV is characterized by low toxicity and good tolerability. There were no reports of special adverse events caused by LMV. Conclusions: Our experiences confirm the effectiveness and safety of letermovir prophylaxis, and suggest that this prophylaxis should be started as soon as possible after the infusion of stem cells, preferably no later than day 14. Moreover, our findings indicate that some patients could benefit from extended letermovir prophylaxis beyond 100 days after transplant.

Abstract

Introduction: Letermovir (LMV) is a new, cytomegalovirus (CMV)-specific, antiviral drug, approved in 2018 for CMV prophylaxis in patients after allogeneic hematopoietic transplantation. The introduction of letermovir prophylaxis has changed the management of CMV infection: it has reduced the incidence of CMV infections and CMV-related complications, and also improved the overall survival in CMV seropositive patients. However, until recently, due to its high treatment cost, prophylaxis with letermovir has not beeen a standard of care in Poland. Material and methods: To confirm the effectiveness and safety of letermovir prophylaxis, we collected real-life data from eight Polish transplant centers, in which a total of 53 patients were treated with letermovir, including off-label use. Results: LMV is characterized by low toxicity and good tolerability. There were no reports of special adverse events caused by LMV. Conclusions: Our experiences confirm the effectiveness and safety of letermovir prophylaxis, and suggest that this prophylaxis should be started as soon as possible after the infusion of stem cells, preferably no later than day 14. Moreover, our findings indicate that some patients could benefit from extended letermovir prophylaxis beyond 100 days after transplant.

Get Citation

Keywords

cytomegalovirus infection, allogeneic hematopoietic stem cell transplantation, letermovir, antiviral prophylaxis

About this article
Title

Real-life experiences of letermovir prophylaxis for cytomegalovirus infection in patients after hematopoietic stem cell transplantation: Polish Acute Leukemia Group (PALG) analysis

Journal

Acta Haematologica Polonica

Issue

Vol 53, No 5 (2022)

Article type

Original research article

Pages

350-354

Published online

2022-10-02

Page views

930

Article views/downloads

98

DOI

10.5603/AHP.a2022.2047

Bibliographic record

Acta Haematol Pol 2022;53(5):350-354.

Keywords

cytomegalovirus infection
allogeneic hematopoietic stem cell transplantation
letermovir
antiviral prophylaxis

Authors

Anna Łojko
Jan Styczyński
Barbara Nasiłowska-Adamska
Joanna Mańko
Krzysztof Kałwak
Patrycja Mensah-Glanowska
Jarosław Dybko
Maciej Majcherek
Anna Czyż
Agnieszka Pluta
Lidia Gil

References (22)
  1. Ljungman P, de la Camara R, Robin C, et al. 2017 European Conference on Infections in Leukaemia group. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019; 19(8): e260–e272.
  2. Teira P, Battiwalla M, Ramanathan M, et al. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis. Blood. 2016; 127(20): 2427–2438.
  3. Boeckh M, Nichols WG. The impact of cytomegalovirus serostatus of donor and recipient before hematopoietic stem cell transplantation in the era of antiviral prophylaxis and preemptive therapy. Blood. 2004; 103(6): 2003–2008.
  4. Marty FM, Ljungman PT, Chemaly RF, et al. Letermovir Prophylaxis for Cytomegalovirus in Hematopoietic-Cell Transplantation. N Engl J Med. 2017; 377(25): 2433–2444.
  5. Chemaly RF, Ullmann AJ, Stoelben S, et al. AIC246 Study Team. Letermovir for cytomegalovirus prophylaxis in hematopoietic-cell transplantation. N Engl J Med. 2014; 370(19): 1781–1789.
  6. Czyżewski K, Styczyński J, Giebel S, et al. for Polish Society of Pediatric Oncology and Hematology and Polish Society of Hematology and Blood Transfusion. Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation: lesson from the nationwide study. Ann Hematol. 2019; 98(9): 2197–2211.
  7. Styczyński J. Prophylaxis vs preemptive therapy in prevention of CMV infection: new insight on prophylactic strategy after allogeneic hematopoietic cell transplantation. Acta Haematol Pol. 2020; 51(1): 17–23.
  8. Schmidt-Hieber M, Labopin M, Beelen D, et al. CMV serostatus still has an important prognostic impact in de novo acute leukemia patients after allogeneic stem cell transplantation: a report from the Acute Leukemia Working Party of EBMT. Blood. 2013; 122(19): 3359–3364.
  9. Green ML, Leisenring W, Xie Hu, et al. Cytomegalovirus viral load and mortality after haemopoietic stem cell transplantation in the era of pre-emptive therapy: a retrospective cohort study. Lancet Haematol. 2016; 3(3): e119–e127.
  10. Frange P, Leruez-Ville M. Maribavir, brincidofovir and letermovir: efficacy and safety of new antiviral drugs for treating cytomegalovirus infections. Med Mal Infect. 2018; 48(8): 495–502.
  11. Styczyński J, Tridello G, Xhaard A, et al. Use of letermovir in off-label indications: Infectious Diseases Working Party of European Society of Blood and Marrow Transplantation retrospective study. Bone Marrow Transplant. 2021; 56(5): 1171–1179.
  12. Kilgore JT, Becken B, Varga MG, et al. Use of letermovir for salvage therapy for resistant cytomegalovirus in a pediatric hematopoietic stem cell transplant recipient. J Pediatric Infect Dis Soc. 2020; 9(4): 486–489.
  13. Styczyński J, Czyżewski K, Dębski R. Primary prophylaxis with letermovir for prevention of CMV infection in two children. Acta Haematol Pol. 2020; 51(4): 263–264.
  14. Pérez Marín M, Decosterd LA, Andre P, et al. Compassionate use of letermovir in a 2-year-old immunocompromised child with resistant cytomegalovirus disease. J Pediatric Infect Dis Soc. 2020; 9(1): 96–99.
  15. Ljungman P, Schmitt M, Marty FM, et al. A mortality analysis of letermovir prophylaxis for cytomegalovirus (CMV) in CMV-seropositive recipients of allogeneic hematopoietic cell transplantation. Clin Infect Dis. 2020; 70(8): 1525–1533.
  16. Mori Y, Jinnouchi F, Takenaka K, et al. Efficacy of prophylactic letermovir for cytomegalovirus reactivation in hematopoietic cell transplantation: a multicenter real-world data. Bone Marrow Transplant. 2021; 56(4): 853–862.
  17. Derigs P, Radujkovic A, Schubert ML, et al. Letermovir prophylaxis is effective in preventing cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation: single-center real-world data. Ann Hematol. 2021; 100(8): 2087–2093.
  18. Malagola M, Pollara C, Polverelli N, et al. Advances in CMV management: a single center real-life experience. Front Cell Dev Biol. 2020; 8: 534268.
  19. Restelli U, Croce D, Pacelli V, et al. Cost-effectiveness analysis of the use of letermovir for the prophylaxis of cytomegalovirus in adult cytomegalovirus seropositive recipients undergoing allogenic hematopoietic stem cell transplantation in Italy. Infect Drug Resist. 2019; 12: 1127–1138.
  20. Huntley D, Talaya A, Giménez E, et al. Features of cytomegalovirus DNAemia blips in allogeneic hematopoietic stem cell transplant recipients: implications for optimization of preemptive antiviral therapy strategies. Biol Blood Marrow Transplant. 2020; 26(5): 972–977.
  21. Cassaniti I, Colombo AA, Bernasconi P, et al. Positive HCMV DNAemia in stem cell recipients undergoing letermovir prophylaxis is expression of abortive infection. Am J Transplant. 2021; 21(4): 1622–1628.
  22. Shigle TL, Handy VW, Chemaly RF. Letermovir and its role in the prevention of cytomegalovirus infection in seropositive patients receiving an allogeneic hematopoietic cell transplant. Ther Adv Hematol. 2020; 11: 2040620720937150.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via Medica Publishers

ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
phone +48 58 320 94 94, fax+48 58 320 94 60,

e-mail: journals@viamedica.pl