Letermovir for Cytomegalovirus Prevention in Adolescent Patients Following Hematopoietic Cell Transplantation

Daukshus, Nicole P; Cirincione, Anthony; Siver, Molly; Mathew, Sherry; Kunvarjee, Binni; Chan, Amelia; Boelens, Jaap Jan; Seo, Susan K.; Papanicolaou, Genovefa A.; Kernan, Nancy A.

doi:10.1093/jpids/piac017

Cited by 17 publications

(21 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Letermovir has been Food and Drug Administration (FDA) approved for CMV prophylaxis in adult HSCT recipients aged 18 years or older, though has not yet received approval for use in children ( 27 ). Despite this, several centers have begun using letermovir in pediatric HSCT patients and have reported promising outcomes ( 39 – 42 ). Maribavir is the newest antiviral to have received FDA approval.…”

Section: Prevention Strategiesmentioning

confidence: 99%

“…In this case, the patient also briefly received letermovir in the setting of ARDS and concern for CMV pneumonia. As noted previously, letermovir is not FDA approved for CMV prophylaxis or treatment in children, though is used off-label at some pediatric centers for prophylaxis and in select cases reported as salvage therapy ( 39 – 42 , 86 – 88 ). With the lack of treatment options in resistant CMV infection, the favorable side effect profile of letermovir (including less bone marrow toxicity) and lack of cross-resistance with other antivirals (due to different therapeutic target sites), interest in the use of letermovir as salvage therapy has grown.…”

Section: Clinical Case Examplesmentioning

confidence: 99%

See 1 more Smart Citation

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

et al. 2022

View full text Add to dashboard Cite

Cytomegalovirus (CMV), like other herpesviruses, has the unique ability to establish latent infection with subsequent reactivation during periods of stress and immunosuppression. Herpesviruses cause potentially devastating disease, particularly in hematopoietic stem cell transplant (HSCT) recipients. CMV is especially of concern in HSCT recipients given the high community seroprevalence, high risk of reactivation and high risk of transmission from HSCT donors to recipients causing primary infection after transplantation. The risk of CMV infection and severity of CMV disease varies depending on the underlying disease of the HSCT recipient, donor and recipient CMV status prior to HSCT, type of conditioning therapy in preparation for HSCT, allogeneic versus autologous HSCT, donor graft source, timing of infection in relation to HSCT, and other patient comorbidities. Different strategies exist for prevention (e.g., preemptive therapy vs. universal prophylaxis) as well as management of CMV disease (e.g., antiviral therapy, augmenting immune reconstitution, cytotoxic T-cell therapy). The purpose of this narrative review is to discuss diagnosis, prevention, and management of CMV infection and disease at different stages of HSCT, including key points illustrated through presentations of complex cases and difficult clinical scenarios. Traditional and novel strategies for CMV management will be discussed in the context of these unique clinical cases.

show abstract

Section: Prevention Strategiesmentioning

confidence: 99%

Section: Clinical Case Examplesmentioning

confidence: 99%

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…CMV infection is associated with higher non-relapse mortality (NRM) and all-cause mortality [3]. CMV reactivation happens in up to 70% of CMV-seropositive recipients (R+) [4,5]. The most common clinical manifestations of CMVi in HSCT patients include pneumonia, hepatitis, enteritis, retinitis and bone marrow suppression.…”

Section: Introductionmentioning

confidence: 99%

“…Studies on LMV used as primary prophylaxis proved its high efficacy at reducing the incidence of CMV disease and the number of deaths caused by CMVi [2][3][4][5][6][7]11]. In 2017, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved LMV for primary prophylaxis in CMV-seropositive adult patients undergoing allogeneic HSCT (allo-HSCT) [2-8, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

“…However, it was not registered for CMVi preemptive treatment, CMVi secondary prophylaxis, or the treatment of CMV disease [2,3,7]. 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 [1][2][3][4][5][6][7][8][10][11][12]. The aim of this study was to summarize reported data on the efficacy and safety of LMV in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Letermovir use in children after hematopoietic cell transplantation: summary of reported data

Styczyński

Sadlok²,

Richert-Przygońska³

et al. 2023

Acta Haematol Pol.

View full text Add to dashboard Cite

show abstract

Letermovir for Cytomegalovirus prophylaxis in pediatric hematopoietic stem cell transplantation

Chen,

David,

Barthelmess

et al. 2023

Pediatric Blood & Cancer

View full text Add to dashboard Cite

BackgroundLetermovir (LTV), an antiviral with exclusive activity against Cytomegalovirus (CMV), is approved for prophylaxis of CMV infection and disease in adult hematopoietic cell transplant (HCT) patients. The use of LTV in the pediatric HCT population is off‐label, and has limited literature to support its use.ProcedureThis was a single‐center, retrospective, matched (1:1 LTV:non‐LTV) cohort study of allogeneic HCT recipients transplanted at Children's Hospital Colorado from 2015 to 2022. The primary endpoint was clinically significant CMV DNAemia (defined as a CMV viral load >1000 copies/mL or any CMV DNAemia leading to preemptive treatment) through 6 months post transplant. Secondary outcomes included time to clinically significant CMV DNAemia, drug adverse effects, and dose adjustments of concomitant cyclosporine and voriconazole (known drug interactions).ResultsWe compared 41 patients who received LTV prophylaxis to 41 patients who received no CMV prophylaxis. There was less clinically significant CMV DNAemia through D+180 in the LTV group (9.8% vs. 17.0%, p = .33). Overall, LTV was well tolerated, and 87.8% of patients experienced no adverse effects related to the drug. There was no observed pattern in LTV effect on cyclosporine serum concentrations, but LTV was associated with decreased voriconazole trough levels.ConclusionsIn this retrospective study, the use of LTV prophylaxis in pediatric stem cell patients was associated with reduced clinically significant CMV DNAemia through D+180.

show abstract

Letermovir for Cytomegalovirus Prevention in Adolescent Patients Following Hematopoietic Cell Transplantation

Cited by 17 publications

References 12 publications

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

Letermovir use in children after hematopoietic cell transplantation: summary of reported data

Letermovir for Cytomegalovirus prophylaxis in pediatric hematopoietic stem cell transplantation

Contact Info

Product

Resources

About