Frontiers in Oncology (Sep 2021)

Letermovir Prophylaxis for Cytomegalovirus Infection in Allogeneic Stem Cell Transplantation: A Real-World Experience

  • Massimo Martino,
  • Annalisa Pitino,
  • Mercedes Gori,
  • Benedetto Bruno,
  • Benedetto Bruno,
  • Alessandra Crescimanno,
  • Vincenzo Federico,
  • Alessandra Picardi,
  • Alessandra Picardi,
  • Stefania Tringali,
  • Claudia Ingrosso,
  • Paola Carluccio,
  • Domenico Pastore,
  • Gerardo Musuraca,
  • Annalisa Paviglianiti,
  • Adriana Vacca,
  • Bianca Serio,
  • Gabriella Storti,
  • Nicola Mordini,
  • Salvatore Leotta,
  • Michele Cimminiello,
  • Lucia Prezioso,
  • Barbara Loteta,
  • Anna Ferreri,
  • Fabrizia Colasante,
  • Emanuela Merla,
  • Luisa Giaccone,
  • Luisa Giaccone,
  • Alessandro Busca,
  • Maurizio Musso,
  • Renato Scalone,
  • Nicola Di Renzo,
  • Serena Marotta,
  • Patrizio Mazza,
  • Pellegrino Musto,
  • Immacolata Attolico,
  • Carmine Selleri,
  • Filippo Antonio Canale,
  • Marta Pugliese,
  • Giovanni Tripepi,
  • Gaetana Porto,
  • Giovanni Martinelli,
  • Angelo Michele Carella,
  • Claudio Cerchione

DOI
https://doi.org/10.3389/fonc.2021.740079
Journal volume & issue
Vol. 11

Abstract

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Despite effective treatments, cytomegalovirus (CMV) continues to have a significant impact on morbidity and mortality in allogeneic stem cell transplant (allo-SCT) recipients. This multicenter, retrospective, cohort study aimed to evaluate the reproducibility of the safety and efficacy of commercially available letermovir for CMV prophylaxis in a real-world setting. Endpoints were rates of clinically significant CMV infection (CSCI), defined as CMV disease or CMV viremia reactivation within day +100-+168. 204 adult CMV-seropositive allo-SCT recipients from 17 Italian centres (median age 52 years) were treated with LET 240 mg/day between day 0 and day +28. Overall, 28.9% of patients underwent a haploidentical, 32.4% a matched related, and 27.5% a matched unrelated donor (MUD) transplant. 65.7% were considered at high risk of CSCI and 65.2% had a CMV seropositive donor. Low to mild severe adverse events were observed in 40.7% of patients during treatment [gastrointestinal toxicity (36.3%) and skin rash (10.3%)]. Cumulative incidence of CSCI at day +100 and day +168 was 5.4% and 18.1%, respectively, whereas the Kaplan-Meier event rate was 5.8% (95% CI: 2.4-9.1) and 23.3% (95% CI: 16.3-29.7), respectively. Overall mortality was 6.4% at day +100 and 7.3% at day +168. This real-world experience confirms the efficacy and safety of CMV.

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