Letermovir as Prophylaxis and Treatment of Cytomegalovirus in Children Undergoing Hematopoietic Stem Cell Transplantation, Experience from a Single Pediatric Center.
Keywords:
Letermovir, CMV, Prophylaxis, ChildrenAbstract
Cytomegalovirus (CMV) infection is a frequent complication in patients receiving Hematopoietic stem cell transplantation (HSCT), this is associated with greater morbidity and mortality. Letermovir was approved by the FDA for CMV prophylaxis in seropositive adult HSCT recipients. There is limited information in pediatrics.
The aim was to evaluate the use of letermovir for prophylaxis and treatment of CMV infection in HIV-positive pediatric HSCT recipients.
Single-center, retrospective, descriptive, observational study from April 2020 to December 2022 in 4 patients aged 1 to 16 years who underwent allogeneic HSCT.
Results: In 1 patient letermovir was used as prophylaxis and in 3 patients it was used as a combination treatment, assuming clinical refractoriness, with foscarnet, ganciclovir or valganciclovir. The doses used were 6 to 13 mg/kg/day. The patient who used letermovir as prophylaxis was not CMV reactive, while in the 3 in which it was used as treatment, the viral load was negativized and/or decreased but subsequent reactivation was not prevented, this coincided with the increase in immunosuppression. The administration was well tolerated without relevant adverse effects.
Conclusions: Although the series of cases presented is very small, the data show that a change in the evolution and management of CMV infection is possible, either as prophylaxis or treatment in patients refractory to usual treatments.
More studies are necessary to confirm the safety, dosage and effectiveness of letermovir in children.
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