PGY2 Oncology Pharmacy Resident Atrium Health Wake Forest Baptist Winston-Salem, North Carolina, United States
Poster Abstract: Background/Rationale:
Cytomegalovirus (CMV) is an opportunistic pathogen that can be reactivated with stress and/or immunosuppression. CMV reactivation is most significant in patients undergoing allogeneic stem cell transplant (alloSCT) whose CMV status is recipient and donor positive (R+/D+) and those with graft versus host disease (GVHD) requiring systemic corticosteroids.
In 2021, the American Society for Transplantation and Cellular Therapy (ASTCT) and their Transplant Infectious Disease Special Interest Group provided guidance on CMV infection and disease after SCT. For centers that conduct alloSCTs, it is recommended that CMV prophylaxis follows a preemptive strategy for those at highest risk of reactivation.
Letermovir, an agent that disrupts viral DNA processing and repackaging by inhibiting the CMV DNA terminase complex, was approved in 2017 for preventing CMV reactivation in adult CMV seropositive alloSCT recipients. Prior literature by Marty et al. suggests that patients receiving letermovir prophylaxis developed significantly less CMV infections compared to placebo. However, current recommendations lack evidence for the use of letermovir in recipient negative, donor positive patients.
Objective(s):
The primary objective of this study is to compare the incidence of CMV infection through D+100 in recipient negative, donor positive, alloSCT patients who did or did not receive letermovir. Secondary objectives will assess CMV development at week 24, time to CMV infection, GVHD development, time to engraftment and hospitalization from CMV.
Methods:
This study was an IRB-approved, single-center retrospective chart review performed at a large academic medical center. Adult patients (18 years or older) who received an alloSCT between October 1st, 2019 and September 30th, 2023 were included. Eligible patients were CMV recipient status negative, and donor positive. Data was obtained from the study site transplant registry.
Results (further analysis pending):
A total of 20 patients were identified who received an alloSCT with CMV seronegative donor (male = 9). Thirteen patients received a matched unrelated donor, six had a haploidentical transplant, and one patient had a matched related donor. Nine patients were prescribed letermovir; only 1 patient developed CMV infection.
Conclusion:
Final analysis ongoing.
References (must also be included in final poster): 1. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients global perspective [published correction appears in Biol Blood Marrow Transplant. 2010 Feb;16(2):294. Boeckh, Michael A [corrected to Boeckh, Michael J]]. Biol Blood Marrow Transplant. 2009;15(10):1143-1238. doi:10.1016/j.bbmt.2009.06.019
2. Hakki M, Aitken SL, Danziger-Isakov L, et al. American Society for Transplantation and Cellular Therapy Series: #3-Prevention of Cytomegalovirus Infection and Disease After Hematopoietic Cell Transplantation. Transplant Cell Ther. 2021;27(9):707-719. doi:10.1016/j.jtct.2021.05.001
3. Marty FM, Ljungman P, Chemaly RF, et al. Letermovir Prophylaxis for Cytomegalovirus in Hematopoietic-Cell Transplantation. N Engl J Med. 2017;377(25):2433-2444. doi:10.1056/NEJMoa1706640
