Roy F. Chemaly, MD, MPH, FACP, FIDSA, Professor, Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, at the University of Texas MD Anderson Cancer Center in Houston, TX, was interviewed by Yael Waknine of Univadis at the TCT meeting held February 20-24, 2019, in Houston, TX.
- Cytomegalovirus (CMV) infection is a common issue after allogeneic hematopoietic stem cell transplant (allo-HCT).
- Letermovir was approved in 2017 by the U.S. Food and Drug Administration for CMV prophylaxis in CMV-positive allo-HCT recipients.
- In a real-world study of 121 patients, 76% received letermovir; insurance coverage was the primary barrier to treatment.
- Letermovir yielded a 65.4% reduced rate of clinically significant CMV infection (18% vs 52%; P<.01 defined as viremia or disease necessitating preemptive therapy.>
- CMV reactivation after day 100 was limited to high-risk patients, such as those with graft vs host disease or receiving steroids.
- “The duration of letermovir prophylaxis, actually up to only day 100, may not be the optimal strategy in some patients who are really at high risk [for CMV reactivation],” Dr. Chemaly pointed out, noting that an extended course may be required in a subset of patients and will be investigated in future studies.