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Human cytomegalovirus-specific T-cell responses and immune-guided strategies as predictors of clinically significant infection in hematopoietic stem cell transplant recipients after letermovir prophylaxis

Bone Marrow Transplantation (2026)Cite this article

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To the Editor:

Letermovir (LTV) prophylaxis has significantly reshaped human cytomegalovirus (HCMV) management in hematopoietic stem cell transplant recipients (HSCTRs), providing a non-myelotoxic alternative to pre-emptive therapy (PET) with ganciclovir [1].

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Fig. 1: HCMV-specific T-cell response measured at the end of prophylaxis in Controllers (CTR) and Non-controllers (Non-CTR).

Data availability

The data that support the findings of this study are available on reasonable request from the corresponding author.

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Acknowledgements

The authors thank the nurses of the Haematology Division for obtaining the patient samples and Daniela Sartori for manuscript editing.

Funding

Ministero della Salute, Ricerca Corrente (grant no. 08075023) and Ricerca Finalizzata (grant no. RF-2019-12370797).

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Authors and Affiliations

  1. Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Dalila Mele, Federica Zavaglio, Giulia Grassia, Elizabeth Iskandar, Irene Cassaniti, Fausto Baldanti & Daniele Lilleri

  2. Chair of Hematology, University of Brescia; Adult Bone Marrow Transplant Unit, Program of Cellular Therapy and Research in Hematology, ASST Spedali Civili di Brescia, Brescia, Italy

    Michele Malagola, Gloria Vaira & Domenico Russo

  3. National PhD Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

    Elizabeth Iskandar

  4. Unit of Bone Marrow Transplantation, Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Valentina Zoboli, Antonio Bianchessi, Irene Defrancesco & Nicola Polverelli

  5. Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy

    Irene Cassaniti & Fausto Baldanti

Authors
  1. Dalila Mele
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  2. Michele Malagola
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  3. Federica Zavaglio
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  4. Giulia Grassia
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  7. Gloria Vaira
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  8. Antonio Bianchessi
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  9. Irene Defrancesco
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  11. Irene Cassaniti
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  12. Domenico Russo
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  13. Fausto Baldanti
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  14. Daniele Lilleri
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Contributions

FB and IC supervised the team, obtained funding and had leadership responsibility for the research activity planning and execution. DL and DM provided substantial contributions to the conception and design of the study, acquisition, analysis and interpretation of data, and revised the manuscript critically for important intellectual content. FZ, GG and EI contributed to the acquisition, analysis and validation of data. MM, VZ, GV, AB, ID and NP enrolled patients, collected and managed the data. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Irene Cassaniti.

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Competing interests

The authors declare no competing interests.

Ethics approval

All participants provided written informed consent. The study was approved by the local Ethics Committee (Comitato Etico Area Pavia) and the Institutional Review Board (Proc. 2022-3.11/451).

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Mele, D., Malagola, M., Zavaglio, F. et al. Human cytomegalovirus-specific T-cell responses and immune-guided strategies as predictors of clinically significant infection in hematopoietic stem cell transplant recipients after letermovir prophylaxis. Bone Marrow Transplant (2026). https://doi.org/10.1038/s41409-025-02788-8

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