ArticleFrontiers in cellular and infection microbiology2025
Increased EBV infection and relapse following haploidentical hematopoietic cell transplantation in the era of letermovir for cytomegalovirus prophylaxis: a propensity score matching analysis.
Article in Frontiers in cellular and infection microbiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Viral Reactivation in Immunocompetent Critically Ill Patients.Microorganisms · 2026Review
- Incidence and risk factors of Epstein-Barr virus infection and post-transplant lymphoproliferative disorder in paediatric haploidentical allogeneic hematopoietic stem cell transplantation.Bone marrow transplantation · 2026Article
- The application of rituximab during the conditioning regimen prevents Epstein - Barr virus infection following rATG-based haploidentical hematopoietic stem cell transplantation in the era of letermovir for cytomegalovirus prophylaxis.Frontiers in immunology · 2026Article
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13 authors.
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Abstract
Background: Letermovir (LTV) is an effective strategy for cytomegalovirus (CMV) reactivation prophylaxis and is increasingly used for allogeneic hematopoietic stem cell transplantation. However, it carries the risk of delayed immune reconstitution. This retrospective study assessed the impact of primary LTV prophylaxis on viral infections, disease relapse, and immune reconstitution in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) recipients. Methods: Among 462 patients from Nanfang Hospital, propensity score matching created two cohorts: 106 with LTV prophylaxis and 212 without LTV prophylaxis. EBV/CMV infection, relapse, and survival were analyzed by competing risk models and Cox regression. Immune reconstitution and function were assessed by flow cytometry. Results: LTV prophylaxis had protective effects against CMV viremia, with a 1-year incidence of 32.1% in the LTV group compared with 46.2% in the non-LTV group (P = 0.009). However, the 1-year cumulative incidence of EBV viremia was significantly higher in the LTV group than in the non-LTV group (38.7% vs.13.7%, P<0.001). On multivariate analysis, LTV prophylaxis was a protective factor for CMV viremia (HR = 0.54, P = 0.014) but a risk factor for EBV viremia (HR = 2.69, P<0.001). Additionally, the 1-year cumulative incidence of relapse post-HSCT was notably higher in the LTV group than in the non-LTV group (13.2% vs. 6.1%, P = 0.032). In multivariate analysis, LTV prophylaxis was an independent risk factor for relapse (HR = 2.56, P = 0.024). Lymphocyte subset counts and functions post-transplantation were significantly lower in the LTV group than in the non-LTV group. Conclusion: LTV prophylaxis might play a dual role in haplo-HSCT recipients, reducing CMV infection but increasing EBV infection and relapse.
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