Cytomegalovirus Viremia and Death After Hematopoietic Cell Transplantation: More Complex Than “To Have and Have Not”?

Perales, Miguel-Ángel; Papanicolaou, Genovefa A.

doi:10.1093/cid/ciz492

Cited by 1 publication

(1 citation statement)

References 11 publications

(17 reference statements)

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“…Based on its mechanism, which involves binding to pUL56 to cause DNA terminase inhibition and subsequently prevent packaging of concatemeric DNA, it is proposed that letermovir's later impact in the CMV replication cycle may provide potential immunologic benefits. The resulting noninfectious CMV DNA fragments, often referred to as dense bodies or blips, may be detected in up to 30% of HSCT recipients [26][27][28][29]. Letermovir's later stage activity differs from traditional agents which terminate DNA polymerase to prevent production and release of CMV DNA, generally avoiding low-level DNAemia [28].…”

Section: Use Of Extended Prophylaxis and Impact On Immune Reconstitutionmentioning

confidence: 99%

A new direction for cytomegalovirus prophylaxis among transplant recipients: Benefits and nonviral outcomes of letermovir use as primary CMV prophylaxis

Moore,

Boutin,

Tanna

2023

Current Opinion in Infectious Diseases

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Purpose of review Letermovir has changed the game of primary prophylaxis against cytomegalovirus (CMV) for hematopoietic stem cell transplant (HSCT) and more recently, solid organ transplant recipients. This is largely due to letermovir's similar efficacy in protecting against CMV reactivation and disease, along with its superior safety profile, notably reduced myelotoxicity, and lack of renal dose adjustment compared to standard agents like valganciclovir. This review will describe the potential benefits and clinical considerations of letermovir as prophylaxis among transplant recipients, with a focus on recent evidence describing nonviral outcomes of CMV. Recent findings Recent evidence has demonstrated improved safety (e.g., less myelosuppression) and tolerability with no difference in rates of CMV infection or disease in kidney transplant recipients given letermovir compared to valganciclovir. Real-world studies and meta-analyses in HSCT populations have explored various nonviral outcomes with letermovir use. Letermovir prophylaxis was associated with reduced mortality, lower rates of graft versus host disease, delayed CMV immune reconstitution, improved tolerability with extended durations, and decreased healthcare utilization. Summary Letermovir is an effective antiviral agent for CMV prevention and has demonstrated enhanced safety, which may allow for extended durations of primary prophylaxis among transplant recipients along with other improved clinical outcomes by mitigating the indirect effects of CMV.

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Section: Use Of Extended Prophylaxis and Impact On Immune Reconstitutionmentioning

confidence: 99%

A new direction for cytomegalovirus prophylaxis among transplant recipients: Benefits and nonviral outcomes of letermovir use as primary CMV prophylaxis

Moore,

Boutin,

Tanna

2023

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

show abstract

Cytomegalovirus Viremia and Death After Hematopoietic Cell Transplantation: More Complex Than “To Have and Have Not”?

Cited by 1 publication

References 11 publications

A new direction for cytomegalovirus prophylaxis among transplant recipients: Benefits and nonviral outcomes of letermovir use as primary CMV prophylaxis

A new direction for cytomegalovirus prophylaxis among transplant recipients: Benefits and nonviral outcomes of letermovir use as primary CMV prophylaxis

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