Mortality in Recipients of Allogeneic Haematopoietic Cell Transplantation in the Era of Cytomegalovirus Primary Prophylaxis: A Single-Centre Retrospective Experience

Authors

Anthony Febres-Aldana
Fareed Khawaja
Oscar Morado-Aramburo
Terri Lynn Shigle
Gabriela Rondon
Joseph Sassine
Amy Spallone
Krithika Srinivasan
Jeremy Ramdial
Amin Alousi
Richard Champlin
George Chen
May Daher
Katayoun Rezvani
Ella J Ariza-Heredia
Elizabeth J Shpall
Roy F Chemaly

Publication Date

6-1-2024

Journal

Clinical Microbiology and Infection

DOI

10.1016/j.cmi.2024.03.001

PMID

38460821

PMCID

PMC12265989

PubMedCentral® Posted Date

7-16-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Objectives: Allogeneic haematopoietic cell transplant (allo-HCT) recipients who are cytomegalovirus (CMV)-seronegative have better post-transplant outcomes than CMV-seropositive recipients. Letermovir (LTV) is approved for CMV primary prophylaxis in adults who are CMV-seropositive after allo-HCT, and its use is associated with improved long-term post-transplant outcomes. We analysed whether LTV has affected the relationship between CMV serostatus and post-transplant outcomes.

Methods: We conducted a retrospective single-centre cohort study of allo-HCT recipients, stratified according to donor (D) and recipient (R). CMV serostatus and the use of LTV: D-/R-, R+/LTV-, and R+/LTV+. Outcomes measured were all-cause and non-relapse mortality, clinically significant CMV infection, graft-versus-host disease, and relapse up to week 48 after allo-HCT. The D-/R- group served as the reference for comparisons in univariate, competing risk regression, and cumulative incidence functions.

Results: The analysis included 1071 consecutive allo-HCT recipients: 131 D-/R-, 557 R+/LTV-, and 383 R+/LTV+. All-cause mortality by day 100 was 6.1% for the D-/R- group, compared with 14.0% (p 0.024) and 7.8% (p 0.7) for the R+/LTV- and R+/LTV + groups, respectively. Non-relapse mortality by day 100 was 11.0%, 6.8% and 3.8% for R+/LTV-, R+/LTV+, and D-/R- groups, respectively, without significant difference. When including relapse as a competing event, the hazard ratio for non-relapse mortality was 1.83 (95% CI: 1.12-2.99, p 0.017) for R+/LTV- compared with D-/R- and 1.05 (95% CI 0.62-1.77, p 0.85) for R+/LTV + compared with D-/R-.

Discussion: CMV primary prophylaxis with LTV abrogated the mortality gap based on CMV serostatus, a protective effect that persisted after discontinuation of primary prophylaxis.

Keywords

Adult, Aged, Female, Humans, Male, Middle Aged, Acetates, Cause of Death, Cytomegalovirus, Hematopoietic Stem Cell Transplantation, Incidence, Pre-Exposure Prophylaxis, Proportional Hazards Models, Quinazolines, Recurrence, Retrospective Studies, Transplantation, Homologous, Treatment Outcome

Published Open-Access

yes

Recommended Citation

Febres-Aldana, Anthony; Khawaja, Fareed; Morado-Aramburo, Oscar; et al., "Mortality in Recipients of Allogeneic Haematopoietic Cell Transplantation in the Era of Cytomegalovirus Primary Prophylaxis: A Single-Centre Retrospective Experience" (2024). Faculty, Staff and Student Publications. 4321.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4321