(054) Cytomegalovirus Reactivation Rates: Graft Versus Host Disease Prophylaxis Post-Transplant Cyclophosphamide Based Regimen Compared to Prior Standard of Care

Poster Abstract:

Background: A common and potentially life-threatening infection post-transplant is cytomegalovirus (CMV) during the time of t-cell dysfunction. The recently published phase three randomized controlled trial looking at tacrolimus (FK) and methotrexate (MTX) vs. post-transplant cyclophosphamide (PTCy), FK, and mycophenolate (MMF) post-allogeneic hematopoietic stem cell transplant for graft verse host disease (GVHD) prophylaxis reported a significant reduction in GVHD and improved relapse-free survival at 1-year post-transplant within the PTCy, FK, and MMF group. The trial results for CMV breakthrough rates were significantly lower than previously reported. Since changing to PTCy in early 2023 post-transplant CMV reactivation in transplant recipients remains a concern. With expanding PTCy to other donor types from the traditional haploidentical protocol there is a need to better quantify CMV risk within other transplant populations.

Objective: The primary purpose of this study is to determine the rates of CMV reactivation in the setting of PTCy with or without letermovir. The results of this study could highlight the importance of adjusting modifiable risk factors for cmv reactivation such as other immunosuppressive agents on board.

Methods: This retrospective study included all adult patients undergoing allogeneic hematopoietic stem cell transplant from an HLA-matched related donor, matched unrelated, or a 7/8 mismatched donor, after reduced-intensity conditioning. Patients were transplanted at Indiana University Health between July of 2022 and July of 2023. The primary endpoint was the incidence of clinically significant breakthrough CMV reactivation at day 100 post-transplant between sirolimus/FK and PTCy/FK/MMF group. Key secondary endpoints include, cmv mortality, cmv reactivation rates for those on letermovir by day 7 compared to day 100, incidence of graft vs host disease, all cause mortality, peak CMV plasma, and the proportion of patients still on immunosuppressants at day 100.

Results: Results pending.

Discussion/

Conclusion: The results of this study could highlight the importance of adjusting modifiable risk factors for cmv reactivation such as other immunosuppressive agents on board. More data is needed to better understand CMV risk with expanded use of PTCy.

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