Related Experiment Video
Updated: Jun 16, 2025
Generation of Multivirus-specific T Cells to Prevent/treat Viral Infections after Allogeneic Hematopoietic Stem Cell Transplant
Published on: May 27, 2011
Letermovir Primary and Secondary Prophylaxis in Pediatric Recipients of Allogeneic Haematopoietic Stem Cell
Francesca Vendemini1, Paola De Lorenzo2, Francesca Romani3
1Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Insights
Letermovir significantly reduced cytomegalovirus (CMV) reactivation in pediatric HSCT patients. This viral termination inhibitor proved safe and effective for both primary and secondary prophylaxis, offering crucial protection against this common complication.
Area of Science:
- Pediatric Hematology-Oncology
- Infectious Diseases
- Transplantation Immunology
Background:
- Cytomegalovirus (CMV) reactivation is a frequent complication following hematopoietic stem cell transplantation (HSCT).
- Letermovir, a viral termination inhibitor, is approved for CMV prophylaxis in adult HSCT recipients.
- Limited data exist on letermovir's efficacy in pediatric HSCT, despite recent FDA approval for this population.
Purpose of the Study:
- To compare CMV reactivation incidence in pediatric HSCT patients receiving letermovir prophylaxis versus historical controls without prophylaxis.
- To identify risk factors for CMV reactivation in IgG seropositive pediatric HSCT recipients.
- To evaluate the impact of CMV reactivation on treatment-related mortality and overall survival.
Main Methods:
- A single-center retrospective study of pediatric HSCT recipients (<21 years) from January 2014 to October 2023.
- Comparison of a cohort receiving letermovir (primary or secondary prophylaxis) with a cohort receiving no prophylaxis.
- Multivariate analysis to identify protective factors against CMV reactivation.
Main Results:
- Letermovir as primary prophylaxis reduced CMV reactivation incidence from 29.5% to 3.7% (P=.0029).
- Letermovir as secondary prophylaxis showed 0% CMV reactivation incidence compared to 34.7% in controls.
- Factors including letermovir use, HLA-identical donor, bone marrow stem cell source, and absence of acute GVHD were protective.
Conclusions:
- Letermovir is a safe and effective agent for preventing CMV reactivation in pediatric HSCT.
- Both primary and secondary prophylaxis with letermovir demonstrate significant benefit.
- Further research can explore long-term outcomes and optimal integration into pediatric HSCT protocols.
Background:
CMV reactivation represents one of the most frequent infectious complications post HSCT. Letermovir is a viral terminate inhibitor which has been approved in adults for the prophylaxis of post HSCT CMV reactivation. Its use in pediatric HSCT recipient was recently approved by US FDA but data on the use of letermovir in children remain limited.
Objective(S):
We aimed at comparing the incidence of CMV reactivation in a more recent cohort of pediatric HSCT recipients receiving primary or secondary prohylaxis with letermovir with a previous cohort of children receiving no prophylaxis. We analyzed the risk factors for CMV reactivation among IgG seropositive recipients and the role of CMV reactivation on treatment related mortality/overall survival.
Study Design:
This is a single center retrospective study which enrolled all consecutive patients aged <21 years who underwent allogeneic HSCT between 1 January 1, 2014 and October 31, 2023 at the pediatric HSCT Unit of the Fondazione IRCCS San Gerardo dei Tintori in Monza RESULTS: 287 patients who received 308 HSCT were analyzed. Three months cumulative incidence of CMV reactivation was 29.5% (95% CI: 24.3-35) in the standard cohort versus 3.7% (95% CI: 0.3-16.3) in the cohort of patients receiving letermovir as primary prophylaxis (P = .0029). The use of letermovir as well as the use of a HLA-identical donor with no serotherapy, bone marrow as a source of stem cell and the absence of acute GVHD were statistically significant protective factors against CMV reactivation at multivariate analysis. At 3 months after discontinuation of preemptive therapy, the cumulative incidence of CMV reactivation was 0% for the 15 patients receiving letermovir as secondary prophylaxis versus 34.7% (SE 5.8, 95% CI: 23.7-46.0) for the 72 patients not receiving secondary prophylaxis.
Conclusions:
Letermovir is safe and efficacious in preventing CMV reactivation in pediatric patients undergoing HSCT in both primary and secondary prophylaxis.
More Related Videos
11:18Expanding Cytotoxic T Lymphocytes from Umbilical Cord Blood that Target Cytomegalovirus, Epstein-Barr Virus, and Adenovirus
Published on: May 7, 2012
10:24Automated Cell Enrichment of Cytomegalovirus-specific T cells for Clinical Applications using the Cytokine-capture System
Published on: October 5, 2015
