EBMT 2022 "moving" together, enjoy the CMV academic feast together!

The 48th European Society for Blood and Marrow Transplantation (EBMT) Annual Meeting 2022 will be held online from March 19-23, 2022
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The EBMT Annual Conference is one of the most influential international conferences in the field of hematological treatment.
The conference covers key topics related to hematopoietic stem cell transplantation (HSCT) and cell therapy research.
More than 5,000 scientists, doctors and nurses from all over the world are present at the conference.
, pharmacists, biologists and other professionals attended the meeting
.

Cytomegalovirus (CMV) infection is a common complication after HSCT, which seriously threatens the survival and prognosis of patients.
It is called "Troll of Transplant".
Let's take a look at CMV at this conference.
related issues and research
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1.
CMV in HSCT - "transplant trolls" should not be underestimated.
Among HSCT patients, CMV infection is at high risk and has a heavy medical burden.
CMV infection is still one of the most important complications after allogeneic HSCT, which can lead to stem cell transplant recipients.
of multiple organ diseases, including pneumonia, hepatitis, gastroenteritis, retinitis, and encephalitis 1 , and have profound adverse effects on transplant outcomes 2
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CMV infection can occur at any time after transplantation 2,3
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The risk factors for CMV infection include: CMV seropositivity of the donor and recipient, pre-transplant conditioning regimen, T cell depletion of the graft, and application of immunosuppressive agents 1
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For better management of CMV, special attention should be paid to highly susceptible high-risk groups based on risk factors
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A retrospective observational study at the meeting grouped enrolled patients according to high-risk factors and found that approximately 90% of patients had an intermediate-to-high-risk CMV infection risk 4
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 Compared with patients without CMV viremia, patients with CMV viremia have higher non-relapse mortality5, higher readmission rates and longer hospital stays5,6
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HSCT patients have poor prognosis in the absence of CMV prophylaxis ≥50% of patients received more than two preemptive CMV treatments without CMV prophylaxis, in addition, patients who received preemptive therapy 50 days after transplantation The risk of all-cause mortality was significantly increased (p=0.
03), and nearly half of the patients had grade 3-4 neutropenia7,8
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For stem cell transplant patients, once CMV infection occurs, it is undoubtedly worse
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Not only does it lead to an increased risk of death, but it also increases post-transplant acute/chronic graft-versus-host disease (GVHD), other opportunistic infections, and healthcare burdens
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The current management methods for CMV infection are mainly prevention and preemptive treatment guided by PCR monitoring, but preemptive treatment is still the main method before CMV-specific preventive drugs are launched
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However, due to the significant adverse reactions such as myelosuppression, nephrotoxicity and cross-drug resistance of preemptively treated anti-CMV infection drugs, there are still some limitations in clinical application9,10
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2.
Advances in the management of CMV infection - CMV prevention is emerging as the main strategy More than half of EBMT adult centers have used Letermovir to prevent CMV infection CMV surveillance and prevention: According to a survey conducted by the Infectious Diseases Working Group (IDWP), In 2019, 97% of centers used PCR to diagnose CMV DNAemia, mostly once or twice a week
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More than 70% of the centers were monitored until 6 months after transplantation
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In the prevention of CMV infection, letermovir was the most commonly used drug for prevention (61.
4%, suitable for adult patients), followed by acyclovir/valacyclovir, 18.
8%; ganciclovir/valacyclovir Ciclovir, 7.
9%; foscarnet, 1%; CMV-CTLs, 1%; others, 9.
9%11
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Treatment of CMV infection and CMV disease: The drugs currently used for first-line treatment are: ganciclovir/valganciclovir, foscarnet, ganciclovir + foscarnet.
The initial preemptive treatment is currently not uniform.
The most common thresholds are: Any positive CMV DNA levels, >102, >103 and >104 copies/ml, accounted for 12.
8%, 16.
1%, 56.
7%, 8.
4%, and 6% others
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CMV-resistant infections were reported in 70 of 180 centers
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Turn passive into active - Letermovir redefines the new pattern of CMV management after stem cell transplantation At the industry seminar of MSD on March 20, 5 industry experts focused on "CMV in HSCT: Breaking down barriers to improve patient outcomes" The topic "CMV in HSCT: Breaking Down Barriers to Improve Patient Outcomes" focuses on the relationship between CMV infection/viremia and clinical outcomes, advances in CMV management, and new treatment strategies
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During the period, Professor Genovefa Papanicolaou from Weill Cornell Medical College in New York, USA emphasized: During the 30-year journey against CMV infection, the mortality rate of HSCT patients has been significantly reduced, and now we should turn to how to better The advent of Letermovir to improve outcomes in HSCT patients and prevent CMV infection provides a shot in the arm to this vision 12-14
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Another professor Matthias Stelljes from Germany presented the current progress of CMV management.
He pointed out: Letermovir is currently the only approved drug with indications for the prevention of CMV infection in HSCT patients, and has a new mechanism of action—target Enzyme to CMV virus terminus
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The efficacy and safety of letermovir have also been validated in a pivotal phase 3 study, and letermovir prophylaxis can significantly reduce CMV infection and all-cause mortality after HSCT without increased myelosuppression and nephrotoxicity (vs.
placebo) 14
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The professor cited several real-world studies of Letermovir, the results of which also showed the significant efficacy of Letermovir for CMV prevention: clinically meaningful reduction in CMV infection rate (47.
0% vs 10.
7%); 180+ Antiviral drug use was significantly reduced after 15 days; after 100 days of continuous use, clinically significant CMV infection was significantly reduced, overall survival was increased, and significant efficacy was consistently maintained in patients with grade 2 or higher GVHD16-18
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Finally, the professor also mentioned the recommendations for the initiation and treatment time of Letermovir: for all seropositive patients, letermovir prophylaxis should be initiated within 1-10 days after transplantation and continued to 100 days
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Because Litemovir has shown good efficacy in many studies, the speaker conducted a questionnaire survey to the participants of the conference during the speech.
The results of the Litemovir survey showed: a.
In Litemovir 81% of participants were willing to choose letermovir as standard treatment for CMV infection prevention in patients with CMV seropositive allogeneic HSCT when movir was available; b.
89% of participants believed that using letermovir compared to preemptive Temovir is less likely to prevent refractory CMV infection
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In addition, there are 5 special studies on Letermovir in this conference, including 1 oral presentation and 4 poster presentations
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In an oral presentation on March 22, Prof.
Roy Chemaly presented a systematic review and meta-analysis of a pool of real-world studies in primary prevention of letermovir 19
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A total of 48 true observational studies were included in this meta-analysis, providing additional evidence for the efficacy of letermovir for the prevention of CMV infection and disease in adults with allogeneic HSCT
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Their results demonstrate that primary CMV prophylaxis with letermovir is effective in reducing the overall risk of CMV manifestations (CMVr, cs-CMVi, CMVd) at 100 days and all-cause mortality and non-relapse at 200 days in adult HSCT recipients Mortality 19
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The study showed: 87% reduction in CMV reactivation at 100-day follow-up; 91% reduction in clinically meaningful CMV infection; 69% reduction in CMV disease; 94% reduction in CMV-related hospitalization; and a reduction in the incidence of grade 2 or higher GVHD 48%
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Consistent results were observed for CMV reactivation, clinically significant CMV infection, and CMV disease at 200 days of follow-up
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Internationally, the management of CMV infection after stem cell transplantation has gradually led to a strategy of temovir prevention.
Letermovir exerts its anti-CMV effect by acting on the virus terminal enzyme, thus avoiding adverse reactions such as bone marrow suppression and nephrotoxicity, while still having a highly effective antiviral effect20-24, the efficacy and safety are in clinical trials and many Validated in a real-world study
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 Summary CMV infection is one of the important and dangerous complications in HSCT patients.
Because of the major adverse effects of past nucleoside drugs—myelosuppression and nephrotoxicity and drug resistance, clinicians have been trying to balance the risk of CMV infection with therapeutic drugs.
associated toxicity
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The emergence of Letermovir has moved the threshold of CMV prevention and control forward, making prevention the mainstream trend in the world.
These are all attributed to its excellent anti-CMV infection ability and excellent safety.
Chinese HSCT patients provide new options
.

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Reviewer: Quinta Typesetting: Quinta pokes "read the original text", let's make progress togetherReview: Quinta Typesetting: Quinta pokes "read the original text", we make progress togetherReview: Quinta Typesetting: Quinta pokes "read the original text", we make progress together