open access
Letermovir use in children after hematopoietic cell transplantation: summary of reported data
Affiliations- Student Scientific Society, Collegium Medicum, Nicolaus Copernicus University, Poland
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Toruń, Jurasz University Hospital 1, Bydgoszcz, Poland
open access
Abstract
Introduction: Letermovir (LMV) is approved for primary prophylaxis of cytomegalovirus infection (CMVi) in CMV-seropositive adult patients undergoing allogeneic hematopoietic stem cell transplantation. However, it is not registered for CMVi preemptive treatment, CMVi secondary prophylaxis, or the treatment of CMV disease. There is very limited data regarding LMV’s use in pediatric patients, as it has not been approved so far as any kind of treatment in children, with its use remaining off label. The aim of this study was to summarize reported data on the efficacy and safety of LMV in pediatric patients.
Material and methods: Studies and case reports regarding LMV’s use in pediatric patients were searched in PubMed.
Results: Overall, nine reports that fulfilled the search criteria, published between 2019 and 2022, were found and analyzed. The total number of cases involved in research was 46 with patient age ranging from 2–19 years; one child was counted twice due to another transplant.
The most common serostatus of donor/recipient was D+/R+ (47%), followed by D–/R+ (42%), then D+/R– (2%), and then unknown (9%). Most patients had received the transplant from a matched unrelated donor (40%). There were 47 incidents of LMV administration as CMV management strategy. The analyzed patients received LMV as primary prophylaxis (74%), secondary prophylaxis (15%), pre-emptive therapy (6%), or treatment of CMV disease (4%). One patient received LMV as a treatment and then as a secondary prophylaxis. In 44/46 (95.6%) cases, no symptomatic CMVi occurred during LMV administration, with only transient CMV DNA-emia present on rare occasions.
Conclusion: The use of LMV is safe in pediatric patients.
Abstract
Introduction: Letermovir (LMV) is approved for primary prophylaxis of cytomegalovirus infection (CMVi) in CMV-seropositive adult patients undergoing allogeneic hematopoietic stem cell transplantation. However, it is not registered for CMVi preemptive treatment, CMVi secondary prophylaxis, or the treatment of CMV disease. There is very limited data regarding LMV’s use in pediatric patients, as it has not been approved so far as any kind of treatment in children, with its use remaining off label. The aim of this study was to summarize reported data on the efficacy and safety of LMV in pediatric patients.
Material and methods: Studies and case reports regarding LMV’s use in pediatric patients were searched in PubMed.
Results: Overall, nine reports that fulfilled the search criteria, published between 2019 and 2022, were found and analyzed. The total number of cases involved in research was 46 with patient age ranging from 2–19 years; one child was counted twice due to another transplant.
The most common serostatus of donor/recipient was D+/R+ (47%), followed by D–/R+ (42%), then D+/R– (2%), and then unknown (9%). Most patients had received the transplant from a matched unrelated donor (40%). There were 47 incidents of LMV administration as CMV management strategy. The analyzed patients received LMV as primary prophylaxis (74%), secondary prophylaxis (15%), pre-emptive therapy (6%), or treatment of CMV disease (4%). One patient received LMV as a treatment and then as a secondary prophylaxis. In 44/46 (95.6%) cases, no symptomatic CMVi occurred during LMV administration, with only transient CMV DNA-emia present on rare occasions.
Conclusion: The use of LMV is safe in pediatric patients.
Keywords
letermovir, children, transplantation, CMV
About this articleTitle
Letermovir use in children after hematopoietic cell transplantation: summary of reported data
Journal
Issue
Article type
Original research article
Pages
31-35
Published online
2023-02-09
Page views
298
Article views/downloads
35
DOI
10.5603/AHP.a2023.0004
Bibliographic record
Acta Haematol Pol 2023;54(1):31-35.
Keywords
letermovir
children
transplantation
CMV
Authors
Tomasz Styczyński
Jagoda Sadlok
Monika Richert-Przygońska
Krzysztof Czyżewski
References (14)- 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.
- 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.
- Czyżewski K, Styczyński J. Real-world experience with letermovir in primary prophylaxis of cytomegalovirus in adult patients after hematopoietic cell transplantation: summary of reported data. Acta Haematol Pol. 2021; 52(3): 182–189.
- Daukshus NP, Cirincione A, Siver M, et al. Letermovir for cytomegalovirus prevention in adolescent patients following hematopoietic cell transplantation. J Pediatric Infect Dis Soc. 2022; 11(7): 337–340.
- Chiereghin A, Belotti T, Borgatti EC, et al. Off-label use of letermovir as preemptive anti-cytomegalovirus therapy in a pediatric allogeneic peripheral blood stem cell transplant. Infect Drug Resist. 2021; 14: 1185–1190.
- Richert-Przygonska M, Jaremek K, Debski R, et al. Letermovir prophylaxis for cytomegalovirus infection in children after hematopoietic cell transplantation. Anticancer Res. 2022; 42(7): 3607–3612.
- 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.
- Cheng CN, Li SS, Yeh YH, et al. Letermovir prophylaxis for cytomegalovirus reactivation in children who underwent hematopoietic stem cell transplantation: A single-institute experience in Taiwan. J Microbiol Immunol Infect. 2022; 55(2): 323–327.
- Jaing TH, Chang TY, Chen SH, et al. Factors associated with cytomegalovirus infection in children undergoing allogeneic hematopoietic stem-cell transplantation. Medicine (Baltimore). 2019; 98(4): e14172.
- Puttkammer J, Kohorst M, Kuhn A. Letermovir as CMV prophylaxis in a pediatric cohort: a retrospective analysis. Transplant Cell Ther. 2022; 28(3): S380–S381.
- 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.
- Strenger V, Sperl D, Kubesch K, et al. Letermovir in paediatric HSCT recipients. J Antimicrob Chemother. 2019; 74(9): 2820–2821.
- Styczynski J, Gałązka P, Czyżewski K, et al. High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: the adverse role of post-transplant CMV replication. Acta Haematol Pol. 2021; 52(5): 483–492.
- Łojko A, Styczyński J, Nasiłowska-Adamska B, et al. Real-life experiences of letermovir prophylaxis for cytomegalovirus infection in patients after hematopoietic stem cell transplantation: Polish Acute Leukemia Group (PALG) analysis. Acta Haematol Pol. 2022; 53(5): 350–354.