(10) Letermovir for Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation

Publication Number: 341

Background: Cytomegalovirus (CMV) reactivation is one of the most commonly occurring infections among allogeneic hematopoietic cell transplant recipients. Allogeneic hematopoietic stem cell transplantation (HSCT) and associated infection make a substantial impact on the public health burden. Although, existing studies investigated the effect of different anti-viral agents for CMV prophylaxis in HSCT. However, there is a scarce of evidence on letermovir used for cytomegalovirus prophylaxis. T

Objectives: The objective of this study to conduct a systematic literature review and meta-analysis to examine the impact of letermovir used for cytomegalovirus prophylaxis in HSCT.

Methods: We systematically searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science using relevant pairing keywords to identify the studies examine the impact of letermovir used for cytomegalovirus prophylaxis in HSCT. The Databases were searched from inception to Jan 2022. Meta-analysis was carried out using Review Manager 5.3. Random effects model was used to compute the pooled estimates of odds ratios (OR) and 95% confidence intervals (CI).

Results: A total of 10 studies meeting the inclusion criteria with overall 260 participants. The median (range) of patients was age 54.13 (17-78). Four RCTs used placebo as comparator, and remaining six cohort studies received foscarnet and other treatment as control group. Results from meta-analysis showed that prophylaxis letermovir significantly reducing the incidence of CMV infection vs. placebo (OR: 0.56, 95% CI: 0.49-0.68, p< 0.05) and control group (OR: 0.68, 95% CI: 0.55-0.74). There is no significant difference found between prophylaxis letermovir and control group in reducing all-cause mortality (OR: 0.92, 95% CI: 0.6-0.54). No significant difference found between letermovir group and control group in serious adverse events.
Moreover, significant difference found between letermovir group and placebo in incidence of all-cause prophylaxis failure (P = 0.002).

Conclusions: The results showed that prophylaxis letermovir significantly reduce the incidence of CMV infection. All cause-prophylaxis failure was dose dependent. However, further RCTs with long term follow-up are required to confirm the current findings.