In a study published in Blood, researchers from the San Raffaele Scientific Institute in Milan have found that letermovir, an antiviral drug used for cytomegalovirus (CMV)infections, reduced chronic graft-versus-host disease risk after hematopoietic cell transplantation (HCT).
One major challenge presented by HCT for hematological malignancies is the development of GVHD. While immunosuppressive treatments improve GVHD risks, there is an increased risk of CMV infection. Although unclear, the relationship between CMV infection and GVHD prevalence after HCT is bidirectional, with CMV potentially leading to GVHD. Further, post-transplantation cyclophosphamide (PTCy), an established GVHD-prophylaxis treatment, increases the risk of CMV infection, which negates the effects of PTCy. Therefore, the authors sought to investigate the use of letermovir post-HCT.
The authors analyzed all adult patients undergoing HCT between February 2016 and February 2021 at their center. In most patients, prophylaxis was calcineurin inhibitor free and based on PTCy with sirolimus, or in combination with mycophenolate mofetil. Letermovir was introduced as of March 1st, 2019 at a daily dose of 480 mg from Day0 to Day+100. Administration of letermovir showed significantly lower hazards for clinically relevant CMV reactivation, and moderate-severe chronic GVHD (cGVHD) hazards, suggesting a protective effect. Taken together, these findings support the use of letermovir post-HCT.
Lorentino F, Xue E, Mastaglio S, et al. Letermovir reduces chronic GVHD risk in calcineurin inhibitor-free GVHD prophylaxis after hematopoietic cell transplantation [published online ahead of print, 2022 Jan 25]. Blood Adv.2022;bloodadvances.2021006213.