Letermovir Prophylaxis Guided by Cytomegalovirus Cell-Mediated Immunity Improves the Outcomes of Allogeneic Hematopoietic Stem Cell Transplant Recipients

作者：Luxiang Wang, Jingtao Huang, Chuanhe Jiang, Meijuan Huang, Xiaojia Guo, Li Su, Zilu Zhang, Jiayu Huang, Haiyang Lu, Zengkai Pan, Jun Zhu, Quan Chen, Yang He, Yang Cao, Xiaoxia Hu · 发表于：Clinical Infectious Diseases · 年份：2025 · DOI：10.1093/cid/ciaf410 · 被引用次数：12 · 研究领域：Cytomegalovirus and herpesvirus research、Virus-based gene therapy research、Immunodeficiency and Autoimmune Disorders

BACKGROUND: The control of cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplantation (allo-HSCT) depends heavily on the reconstitution of CMV-specific cell-mediated immunity (CMV-CMI). This study aimed to assess whether CMV-CMI-guided letermovir prophylaxis is more effective than a fixed-duration approach in reducing the incidence of late-onset clinically significant CMV infection (cs-CMVi). METHODS: This retrospective study included 182 adults who underwent allo-HSCT at 4 participating hospitals. Individuals who received transplantation between June 2022 and April 2023 were treated with a fixed 100-day course of letermovir (fixed-duration group, n = 78), while those receiving transplantation from February 2023 to February 2024 received letermovir based on their CMV-CMI status (CMV-CMI-guided group, n = 104). RESULTS: The 1-year cumulative incidence of late-onset cs-CMVi was significantly lower in the CMV-CMI-guided group compared with the fixed-duration group (9.7% vs 24.8%, P = .019). The CMV-CMI-guided group also had improved overall survival (89.1% vs 77.1%, P = .04) and relapse-free survival (88.4% vs 76.8%, P = .01). Patients were divided into high-risk (n = 36) and low-risk (n = 146) groups, based on risk factors for late-onset cs-CMVi. Among high-risk individuals, the cumulative incidence of late-onset cs-CMVi was significantly lower in the CMV-CMI-guided group than in the fixed-duration group (12.5% vs 46.3%, P = .04). CONCLUSIONS: C...