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Off-Label Use of Letermovir as Preemptive Anti-Cytomegalovirus Therapy in a Pediatric Allogeneic Peripheral Blood Stem Cell Transplant

Authors Chiereghin A, Belotti T, Borgatti EC, Fraccascia N, Piccirilli G, Fois M, Borghi M, Turello G, Gabrielli L, Masetti R, Prete A, Fanti S, Lazzarotto T

Received 12 December 2020

Accepted for publication 19 February 2021

Published 23 March 2021 Volume 2021:14 Pages 1185—1190

DOI https://doi.org/10.2147/IDR.S296927

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Héctor M. Mora-Montes


Angela Chiereghin,1,2 Tamara Belotti,3 Eva Caterina Borgatti,4 Nicola Fraccascia,5 Giulia Piccirilli,6 Maura Fois,3 Michele Borghi,4 Gabriele Turello,4 Liliana Gabrielli,6 Riccardo Masetti,3 Arcangelo Prete,3 Stefano Fanti,5 Tiziana Lazzarotto4

1Section of Microbiology, Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy; 2Department of Public Health, Local Health Authority of Bologna, Bologna, Italy; 3Pediatric Oncology and Haematology Unit “Lalla Seragnoli”, Department of Pediatrics, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy; 4Microbiology Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy; 5Nuclear Medicine Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy; 6Microbiology Unit, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy

Correspondence: Tiziana Lazzarotto
Microbiology Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, via Massarenti 9, Bologna, 40138, Italy
Tel +39 0512143360
Fax +39 0512143514
Email [email protected]

Abstract: Despite the effectiveness of the currently available antiviral drugs in treating cytomegalovirus (CMV) infection, high rates of adverse effects are associated with their use. Moreover, a problem of increasing importance is the emergence of drug-resistant CMV infection. Here, we describe the first case of off-label use of letermovir (LMV) as preemptive antiviral therapy, in a pediatric allogeneic peripheral blood stem cell transplant recipient with ganciclovir-resistant CMV infection who was intolerant to foscarnet and unable to achieve viral clearance after seven doses of cidofovir. After the administration of LMV, a gradual reduction in viral load was observed and within 6 weeks of LMV treatment, after more than 6 months of positive CMV-DNAemia, the patient cleared the infection. No adverse effects associated with LMV were observed during treatment. In this pediatric study case, the off-label use of LMV for the treatment of CMV infection has been well tolerated and proved to be effective in leading to the suppression of viral replication.

Keywords: pediatric allogeneic peripheral blood stem cell transplant, GCV-resistant CMV, intolerance to FOS, off-label letermovir use

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