TCT 2019—Letermovir linked to less CMV infection in CMV-seropositive transplants


  • Tara Haelle
  • Univadis
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Takeaway

  • Patients with cytomegalovirus (CMV) seropositivity who took letermovir after allogeneic hematopoietic cell transplantation (alloHCT) had lower incidence of clinically significant CMV infection and infection requiring antiviral treatment compared with those not taking letermovir.

Why this matters

  • CMV is associated with longer hospital stay, complications, and increased mortality even without relapse in patients who receive alloHCT. 

Study design

  • Single-center retrospective study at MD Anderson Cancer Center involving 121 patients who were CMV IgG-antibody positive and received alloHCT between March 2018 and August 2018, evaluated 100 days posttransplant. 
  • 92 patients (76%) took letermovir and 29 did not; most common reason for not taking letermovir was insurance/cost (59%).
  • Most patients had acute myeloid leukemia; others had myelodysplastic syndrome, chronic myeloid leukemia, acute lymphoblastic leukemia, chronic/small lymphocytic lymphoma, non-Hodgkin lymphoma, myelofibrosis, myeloma, or chronic myelomonocytic leukemia.
  • All patients underwent CMV viral monitoring twice weekly.

Key results

  • Clinically significant CMV infection occurred in 18% taking letermovir vs 52% not taking it (P<.01>
  • Any CMV viremia occurred in 58% taking letermovir vs 79% not (P=.04).
  • Proven or probable CMV disease developed in 5% taking letermovir vs 7% not (P=.77).
  • Mortality was 8% in letermovir group and 10% in those not taking it (P=.64).

Limitations 

  • Retrospective study with a variety of conditions among patients.

 

Highlights from TCT Meetings 2019