Letermovir u pacientů po alogenní transplantaci krvetvorných buněk: přehled literatury.

Abstract

Cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplantation with subsequent antiviral treatment is a significant complication leading to increased morbidity and mortality in these patients. For the prevention of CMV disease, the frequent monitoring of CMV viremia with early preemptive antiviral treatment in case of CMV reactivation, is the most used practice. This approach leads to a low incidence of CMV disease, however, the percentage of CMV reactivations requiring preemptive therapy remains high, with increased morbidity and non-relapse mortality related to CMV reactivation by it self. Letermovir is a new antiviral drug with anti-CMV aktivity that is approved for use in CMV seropositive patients after allogeneic hematopoietic stem cell transplantation. In a randomized, placebo-controlled study that led to the introduction of letermovir in clinical practice, it demonstrated a positive effect in reducing the incidence of clinically significant CMV infection and reduced non-relapse mortality compared to placebo, especially in patients at high risk of CMV disease. Although it is already commonly used in primary CMV prophylaxis after allogeneic hematopoietic transplantation, its use is associated with certain unresolved issues such as the optimal duration of prophylaxis or its use in secondary prophylaxis or preemptive treatment of CMV reactivation. The following article summarizes the currently available data on the use of letermovir in patients after allogeneic hematopoietic stem cell transplantation.