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Letermovir prophylaxis for cytomegalovirus in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 60, pages 422–424 (2025)Cite this article

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Cytomegalovirus (CMV) is one of the most common opportunistic infections in patients undergoing hematopoietic stem cell transplantation (HSCT) [1]. It can lead to multiorgan disease in both the early and late post-transplant stages [2, 3]. Pediatric patients are at a higher risk of developing post-transplant CMV infections compared to adult patients [4]. Letermovir, an antiviral drug that targets CMV DNA terminase, is used to prevent CMV infection in patients undergoing HSCT [5]. Its effectiveness as prophylaxis in post-transplant patients has been well established [6, 7]. However, clinical guidance and application of letermovir in pediatric patients undergoing HSCT remain limited. This retrospective study aimed to evaluate the safety and efficacy of letermovir prophylaxis in pediatric patients and its impact on transplant outcomes in real-world scenarios.

We retrospectively analyzed 178 pediatric patients who underwent allo-HSCT at Children’s Hospital of Soochow University from September 2022 to March 2024 and survived for at least 3 months post-transplant. 80 patients received prophylactic letermovir therapy while 98 patients without prophylaxis served as the control group. Letermovir dosage was administered according to body weight and whether taking cyclosporine (Supplementary Table 1), continuing until 100 days post-transplant (Supplementary Method).

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Fig. 1: Survival and immune status of patients after transplantation according to letermovir.

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The submission to the journal implies that materials described in the manuscript, including all relevant raw data, will be freely available to any researcher wishing to use them for non-commercial purposes, without breaching participant confidentiality.

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Acknowledgements

This work was supported by following grants: The National Key Research and Development Program of China (no.2022YFC2502700), the National Natural Science Foundation of China (NSFC, 82170218, 82470221) to Shaoyan Hu, NSFC 82100229 to Yuanyuan Tian, NSFC 82200177 to Li Gao, NSFC 82470127 to Yixin Hu, NSFC 82300244 to Bohan Li, NSFC 82400264 to Yongping Zhang, Suzhou Projects (DZXYJ202305, GSWS2023048, 2020ZKPB02) to Shaoyan Hu, and the Suzhou Municipal Key Laboratory (SZS201615, SKY2022012, SZS2023014) to Shaoyan Hu. Soochow University of Medical School, ML13101223 to Shaoyan Hu.

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Author notes

  1. These authors contributed equally: Qingwei Wang, Minyuan Liu, Senlin Zhang, Li Gao.

Authors and Affiliations

  1. Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China

    Qingwei Wang, Minyuan Liu, Senlin Zhang, Li Gao, Xinran Chu, Bohan Li, Shengqin Cheng, Yuanyuan Tian, Yongping Zhang, Yixin Hu, Jie Li, Jun Lu, Peifang Xiao, Hu Liu & Shaoyan Hu

  2. Jiangsu Pediatric Hematology and Oncology Center, Suzhou, China

    Yixin Hu, Jun Lu, Peifang Xiao & Shaoyan Hu

  3. Pediatric Hematology & Oncology Key Laboratory of Higher Education Institutions in Jiangsu Province, Suzhou, China

    Shaoyan Hu

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  1. Qingwei Wang
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Contributions

Qingwei Wang, Minyuan Liu, Senlin Zhang, and Li Gao: Data and original draft. Xinran Chu, Bohan Li, Shengqin Cheng: Conceptualization and methodology; Yuanyuan Tian, Yongping Zhang, Yixin Hu, Jie Li, Jun Lu, Peifang Xiao: Investigation and project administration; Hu Liu and Shaoyan Hu: Supervision and writing – review & editing.

Corresponding authors

Correspondence to Hu Liu or Shaoyan Hu.

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The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the Declaration of Helsinki. This study was approved by the Institutional Review Boards at Children’s Hospital of Soochow University (approval number 2020001). Each participating patient’s guardian provided written informed consent to participate in the study.

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Wang, Q., Liu, M., Zhang, S. et al. Letermovir prophylaxis for cytomegalovirus in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 60, 422–424 (2025). https://doi.org/10.1038/s41409-024-02502-0

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