Letermovir for pre‐emptive cytomegalovirus therapy after allogeneic hematopoietic cell transplantation

Abstract

BackgroundCytomegalovirus (CMV) is a common cause of morbidity after allogeneic haematopoietic cell transplantation (alloHCT). Pre‐emptive therapy (PET) with valganciclovir (VGC) is associated with haematological toxicity.MethodsWe included alloHCT patients from 2018 to 2021 where letermovir (LTV) was used for CMV PET because of cytopenias.ResultsTen patients were included. Six received VGC prior to LTV. VGC was commenced at median d42, given for median 40 days. LTV was commenced at median d90, given for median 54 days. At commencement of antiviral, CMV viral load was higher for VGC at 3.7 log10 IU/mL, compared to LTV at 2.9 log10 IU/mL. Viral load reduction occurred at 0.18 log10 IU/mL per week for VGC, compared to 0.17 log10 IU/mL per week for LTV. There was no clinically significant CMV viremia after stopping LTV. Cytopenias improved on LTV.ConclusionLTV was effective in controlling CMV viremia when it was given at a lower starting CMV viral load and later post alloHCT than VGC. Further study is required of LTV as upfront PET following alloHCT. image

Human Cytomegalovirus (HCMV) Genetic Diversity, Drug Resistance Testing and Prevalence of the Resistance Mutations: A Literature Review

“…Letermovir (LMV), the HCMV terminase inhibitor, has been recently approved for prophylaxis in stem cell HCMV-seropositive adult hematopoietic cell transplant recipients [ 36 , 37 ]. Resistance mutations are located mainly in UL56, and rarely in UL89 and UL51-terminase subunits, so there is no cross-resistance with other anti-HCMV drugs [ 38 , 39 ].…”