Efficacy of Extended Letermovir Prophylaxis to Prevent CMV Reactivation in High-Risk Chinese Adults Undergoing Allogeneic HSCT

NCT06812598 | Recruiting DMC

• 1 other identifier: SOOCHOW-WXJ-2024-505
• Study Type: interventional
• Target: 330
• Locations: 1 country
• Sites: 1

Brief Summary

After allogeneic hematopoietic stem cell transplantation (allo-HSCT), recipients are immunocompromised and at increased risk of complications, including cytomegalovirus (CMV) infection. International clinical guidelines for the management of CMV infection post-allo-HSCT recommend three main strategies: minimizing infection risk, prevention, and preemptive therapy. However, traditional antiviral agents have not been approved for CMV prophylaxis in allo-HSCT recipients and are associated with significant adverse effects and the development of resistance, leaving the CMV prevention needs of this patient population unmet. Recent studies have demonstrated that letermovir prevents potent and highly specific antiviral activity against CMV, and it has been approved for CMV prophylaxis within the first 100 days post-allo-HSCT. Furthermore, evidence suggests that extending letermovir administration up to 28 weeks further reduces the risk of CMV infection in the later post-transplant period without increasing drug-related mortality. In China, the post-allo-HSCT CMV prevention strategy faces challenges such as limited treatment options, unclear guideline recommendations, non-standardized drug usage in certain medical institutions, and insufficient monitoring. This study aims to provide robust, evidence-based support for the use of letermovir in high-risk CMV reactivation among adult allo-HSCT recipients, thereby broadening clinical treatment choices.

Conditions

Cytomegalovirus Infections; CMV

Keywords

Letermovir; Allogeneic Hematopoietic Stem Cell Transplantation

Outcome Measures

Primary Outcomes (1)

• The incidence of clinically significant CMV infection (csCMVi) within 24 weeks post-transplant

  csCMVi: the occurrence of CMV disease or CMV viremia requiring preemptive therapy

  within 24 weeks following HSCT

Secondary Outcomes (7)

• Incidence of resistant or refractory CMV infection within 24 weeks post-transplant

  within 24 weeks following HSCT

• Time to initiation of preemptive therapy and duration of treatment for CMV infection within 24 weeks post-transplant

  within 24 weeks following HSCT

• Incidence and severity of acute graft-versus-host disease (GVHD) within 100 days post-transplant

  within 100 days following HSCT

• Incidence and severity of chronic GVHD within 24 weeks post-transplant

  within 24 weeks following HSCT

• Incidence and severity of all adverse events (AEs) within 24 weeks post-transplant

  within 24 weeks following HSCT

Study Arms (2)

Intervention Group

EXPERIMENTAL

The patient will begin receiving prophylactic treatment with letermovir from day 0 to day 28 post-allo-HSCT, at a dose of 480 mg orally once daily. If administered in combination with cyclosporine, the letermovir dose should be reduced to 240 mg orally once daily. Treatment will continue until 24 weeks post-transplant (approximately 170 days). During hospitalization, the study nurse will distribute the medication to the patient according to the treatment protocol and provide guidance on proper administration. The nurse will ensure the patient adheres to the prescribed dosing schedule and will document both the medication distribution and adherence.

Drug: Letermovir (0-24w）

Control Group

OTHER

The patient will begin prophylactic treatment with letermovir from day 0 to day 28 post-allo-HSCT, at a dose of 480 mg orally once daily. If used in combination with cyclosporine, the letermovir dose should be reduced to 240 mg orally once daily. The treatment will continue for up to 14 weeks post-transplant (approximately 100 days). In addition, the usage of the medication will be carefully monitored and documented.

Drug: Letermovir (0-14w）

Interventions

Letermovir (0-24w） DRUG

Patients will begin receiving prophylactic treatment with domestically produced letermovir from day 0 to day 28 post-allo-HSCT, at a dose of 480 mg, administered orally once daily. If used in combination with cyclosporine, the dose should be reduced to 240 mg once daily. The treatment will continue until 24 weeks post-transplant (approximately 170 days).

Intervention Group

Letermovir (0-14w） DRUG

Patients will begin receiving prophylactic treatment with domestically produced letermovir from day 0 to day 28 post-allo-HSCT, at a dose of 480 mg, administered orally once daily. If used in combination with cyclosporine, the dose should be reduced to 240 mg once daily. The treatment will continue until 14 weeks post-transplant (approximately 100 days).

Control Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• The patients have decided to undergo an initial allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• The patients are ≥18 years old.
• The patients are CMV seropositive prior to transplantation.
• The patients have at least one high-risk factor for CMV reactivation, including:
• (1) Haploidentical transplantation, HLA-mismatched transplantation, or unrelated donor transplantation.
• (2) The primary source of stem cells is cord blood. (3) A conditioning regimen including total body irradiation (TBI). (4) A GVHD prophylaxis regimen containing alemtuzumab or high-dose anti-thymocyte globulin (ATG).
• \. The patients are able to comply with the study visit schedule, understand and agree to adhere to all protocol requirements, and have voluntarily signed the informed consent form to participate in the study.
• \. The patients have no plans for reproduction from the date of consent until 90 days after the last dose of the study treatment.

You may not qualify if:

• Patients who have previously received allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• Patients with evidence of CMV viremia at any time prior to enrollment.
• Patients with a history of CMV end-organ disease within 6 months prior to enrollment.
• Patients with suspected or known allergy to letermovir or any active or inactive components of similar drugs.
• Patients with severe hepatic impairment (defined as Child-Pugh Class C).
• Patients with end-stage renal disease with a creatinine clearance \< 10 mL/min.
• Patients requiring mechanical ventilation or experiencing hemodynamic instability at the time of enrollment.
• Patients who received any investigational drug therapy within 28 days prior to enrollment.
• Patients who received or plan to receive any of the following treatments within 28 days prior to enrollment or during the study: cidofovir, CMV immune globulin, or any experimental CMV antiviral drugs/biological therapies.
• Patients who previously participated or are currently participating in any study involving a CMV vaccine or other CMV investigational drugs, or who plan to participate in such studies during this trial.
• Patients who are pregnant or breastfeeding at the time of enrollment or planning to become pregnant within 90 days after the last dose of study medication.
• Patients who test positive for human immunodeficiency virus antibodies (HIV-Ab) at any time prior to randomization, or who test positive for hepatitis C virus antibodies (HCV-Ab) with detectable HCV RNA, or for hepatitis B surface antigen (HBsAg) within 90 days prior to randomization. Laboratory testing for HIV, HBV, or HCV is allowed using locally acceptable methods.
• Patients with active solid malignancies, except for localized basal cell or squamous cell carcinoma of the skin or a condition currently under treatment (e.g., lymphoma).

Sponsors & Collaborators

• The First Affiliated Hospital of Soochow University: lead

Study Sites (1)

Hematology Department, The First Affiliated Hospital of Soochow University

Suzhou, Jiangsu, 215006, China

RECRUITING

MeSH Terms

Conditions

Cytomegalovirus Infections

Interventions

letermovir

Condition Hierarchy (Ancestors)

Herpesviridae Infections; DNA Virus Infections; Virus Diseases; Infections

Study Officials

• Xiaojin Wu, Prof.

  The First Affiliated Hospital of Soochow University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Xiaojin Wu, Prof.

CONTACT

13057493105; wuxiaojin@suda.edu.cn

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 1, 2025
• First Posted: February 6, 2025
• Study Start: December 16, 2024
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: January 21, 2026

Record last verified: 2025-02

Locations

CN (1)