Letermovir Conversion for Cytomegalovirus Prophylaxis in Solid Organ Transplant

Area of Science:

• Transplant medicine
• Infectious diseases
• Hematology

Background:

• Cytomegalovirus (CMV) infection is a significant risk post-solid organ transplant.
• Traditional prophylaxis agents like (val)ganciclovir can cause myelosuppression, limiting their use.
• Letermovir (LTV) is approved for kidney transplant but data on non-renal and multi-organ transplant populations are limited.

Purpose of the Study:

• To assess the efficacy and safety of Letermovir (LTV) for Cytomegalovirus (CMV) prophylaxis in non-renal transplant recipients.
• To evaluate the impact of LTV on white blood cell (WBC) count recovery.
• To determine the incidence of breakthrough CMV infections and identify reasons for switching to LTV.

Main Methods:

• Retrospective, single-center cohort study of 58 non-renal transplant patients converted to LTV from (val)ganciclovir.
• Assessed changes in WBC count from LTV initiation to 30 days post-conversion.
• Documented indications for LTV switch and rates of breakthrough CMV infection.

Main Results:

• Median WBC count increased by +2.07 k/µL post-LTV initiation (p < 0.01).
• Pancytopenia was the most common reason for switching to LTV (45%).
• Breakthrough CMV viremia occurred in 7% of patients without resistance; increased mycophenolate use and decreased G-CSF were observed.

Conclusions:

• Letermovir (LTV) is effective and well-tolerated for CMV prophylaxis in extra-renal transplant patients.
• LTV may serve as a safe alternative for patients experiencing hematologic toxicities with (val)ganciclovir.
• The findings support LTV use across various transplant groups facing CMV prophylaxis challenges.