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Ongoing Research for CMV Management in HSCT Patients

Panelists: Robert J. Soiffer, MD, Dana-Farber Cancer Institute; Genovefa Papanicolaou, MD, Memorial Sloan Kettering Cancer Center
Published: Tuesday, Jan 30, 2018



Transcript: 

Robert J. Soiffer, MD: This seems like a very exciting advance, a really important advance, and one that’s probably going to be somewhat of a game changer for our allogeneic patients who are CMV-seropositive. I’m sure there are a lot of other studies that we’ll want to conduct in the future. Certainly, whether we should be extending therapy beyond the 14 weeks. There was a somewhat arbitrarily picked interval there. Can you comment on any studies that might be worth considering in the future?

Genovefa Papanicolaou, MD: Definitely. As you mentioned, the drug is now approved for the first 14 weeks after transplant, so up to day 100. We know that in our practice, there are patients at risk for CMV well beyond that period. It would be important to address this in a clinical trial to see how letermovir is effective when given for a longer duration, perhaps even through week 24. It would be important to see how letermovir would work as secondary prevention. So, if patients had developed CMV viremia and were treated successfully, what happens? Can we use letermovir for these patients if they are still at high risk? Or what happens to patients who had previously received letermovir and then reactivated and are being treated? Can we use letermovir again in these patients?

I think that CMV prevention in stem cell transplants is only the landing indication for letermovir, given the safety profile. There’s a lot of potential for other settings, including perhaps a congenital CMV infection, that is currently a major problem.

Robert J. Soiffer, MD: Thanks very much for joining us today. I think that the world of transplantation has changed. The prognosis for transplant patients has changed over the years. A great deal of that change has occurred because of improvements in supportive care, particularly in the world of infectious disease. I think this is just another example of the kind of improvement we need to see to benefit all of our patients. Thank you very much.

Transcript Edited for Clarity 

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Transcript: 

Robert J. Soiffer, MD: This seems like a very exciting advance, a really important advance, and one that’s probably going to be somewhat of a game changer for our allogeneic patients who are CMV-seropositive. I’m sure there are a lot of other studies that we’ll want to conduct in the future. Certainly, whether we should be extending therapy beyond the 14 weeks. There was a somewhat arbitrarily picked interval there. Can you comment on any studies that might be worth considering in the future?

Genovefa Papanicolaou, MD: Definitely. As you mentioned, the drug is now approved for the first 14 weeks after transplant, so up to day 100. We know that in our practice, there are patients at risk for CMV well beyond that period. It would be important to address this in a clinical trial to see how letermovir is effective when given for a longer duration, perhaps even through week 24. It would be important to see how letermovir would work as secondary prevention. So, if patients had developed CMV viremia and were treated successfully, what happens? Can we use letermovir for these patients if they are still at high risk? Or what happens to patients who had previously received letermovir and then reactivated and are being treated? Can we use letermovir again in these patients?

I think that CMV prevention in stem cell transplants is only the landing indication for letermovir, given the safety profile. There’s a lot of potential for other settings, including perhaps a congenital CMV infection, that is currently a major problem.

Robert J. Soiffer, MD: Thanks very much for joining us today. I think that the world of transplantation has changed. The prognosis for transplant patients has changed over the years. A great deal of that change has occurred because of improvements in supportive care, particularly in the world of infectious disease. I think this is just another example of the kind of improvement we need to see to benefit all of our patients. Thank you very much.

Transcript Edited for Clarity 
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