"Valutazione della profilassi con Letermovir nei pazienti CMV positivi sottoposti a trapianto di midollo allogenico"

Cytomegalovirus (CMV) is the most common viral infection in allogeneic hematopoietic stem cell transplantation. Developments in molecular diagnostic supported the spread of the pre-emptive therapy (PET), and quantitative Real Time-PCR assays has shown the potential of viral load measurement as a predictor of the infection development in CMV post-transplant management. Most patients require the pre-emptive therapy within the first six months after HSCT, with a significant morbidity and mortality. The most widely used antivirals for PET are ganciclovir and valganciclovir (oral prodrug of ganciclovir). Patients who are refractory to ganciclovir and valganciclovir can be treated with foscarnet. Letermovir is a novel CMV-specific antiviral with no effect on other herpesviruses and acts by inhibiting a component of the viral DNA terminase complex: subunit pUL56, involved in the DNA cleavage and packaging that has no equivalent target enzyme in the human body. We monitored patients with CMV DNA PCR once a week from day 0 until day 180 post-HSCT. We evaluated the efficacy of Letermovir as primary prophylaxis and we retrospectively compared the outcome with patients received standard antiviral prophylaxis therapy (PET). Our experience demonstrates the efficacy of Letermovir in a real-world setting for the prevention of clinically significant CMV infection.