Letermovir in patients after allogeneic haematopoietic stem cell transplantation – literature review

Czech version

Authors: T. Kabut; B. Weinbergerová; M. Lengerová; F. Folber; J. Mayer
Authors‘ workplace: Interní hematologická a onkologická klinika LF MU a FN Brno
Published in: Transfuze Hematol. dnes,28, 2022, No. 1, p. 7-16.
Category: Review/Educational Papers
doi: https://doi.org/10.48095/cctahd20227

Overview

Cytomegalovirus (CMV) reactivation after allogeneic haematopoietic stem cell transplantation and its subsequent antiviral treatment is a significant complication leading to increased morbidity and mortality in these patients. Frequent monitoring of CMV viremia with early pre-emptive antiviral treatment in case of CMV reactivation represents the most widely used option to date for preventing CMV disease. While this approach leads to a low incidence of CMV disease, the percentage of CMV reactivations requiring pre-emptive therapy remains high and increased morbidity and non-relapse mortality are thus associated with CMV reactivation per se. Letermovir is a new antiviral drug with anti-CMV activity approved for use in CMV seropositive patients after allogeneic hematopoietic stem cell transplantation. A randomized, placebo-controlled study that led to the introduction of letermovir into clinical practice demonstrated a positive effect in reducing the incidence of clinically significant CMV infection as well as non-relapse mortality compared to placebo, especially in patients at high risk of CMV disease. Although it is already commonly used in primary CMV prophylaxis after allogeneic hematopoietic transplantation, its use is associated with certain unresolved issues such as the optimal duration of prophylaxis or its use in secondary prophylaxis or pre-emptive treatment of CMV reactivation. The following article summarizes currently available data on the use of letermovir in patients after allogeneic hematopoietic stem cell transplantation.

Keywords:

Prophylaxis – cytomegalovirus – letermovir – allogeneic haematopoietic stem cell transplant

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