Comparison of valganciclovir versus foscarnet for the treatment of cytomegalovirus viremia in adult acute leukemia patients after allogeneic hematopoietic cell transplantation

Abstract

Cytomegalovirus (CMV) reactivation increases treatment-related mortality (TRM) after allogeneic hematopoietic cell transplantation (allo-HCT). We analyzed 141 adult acute leukemia (AL) patients suffered allo-HCT between 2017 and 2021, who developed CMV viremia post-HCT and treated with valganciclovir or foscarnet, to evaluate effectiveness and safety of both drugs. Viremia clearance rates (14 and 21 d post treatment) and toxicities were similar in two groups. However, valganciclovir was associated with a lower cumulative incidence of CMV recurrence within 180 days (16.7% vs. 35.7%, p=0.029) post CMV clearance. Finally, 2-year TRM was lower in valganciclovir group (9.7% ± 0.2% vs. 26.2% ± 0.3%, p = 0.026), result a superior 2-year overall survival (OS; 88.1% ± 5.2% vs. 64.4% ± 5.5%, p = 0.005) and leukemia-free survival (LFS; 82.0% ± 5.9% vs. 58.9% ± 5.6%, p = 0.009). Valganciclovir might decrease CMV viremia recurrence and led to better long-term outcome than foscarnet in adult AL patients developed CMV viremia post-HCT. Considering the inherent biases of retrospective study, well-designed trials are warranted to validate our conclusion.

Keywords:

• Valganciclovir
• foscarnet
• cytomegalovirus
• allogeneic hematopoietic cell transplantation
• acute leukemia

Acknowledgments

All the samples were from Jiangsu Biobank of Clinical Resources.

Informed consent statement

Informed consent was obtained from all individual participants for enrolling relative data into an institutional database. The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by ‘Ethic Committee of the First Affiliated Hospital of Soochow University’, and the approval code is ‘2022-496’.

Disclosure statement

No conflict of interest.

Author contributions

J Chen and DP Wu: conception, design, and financial support of the study. TM Song: review of CMV-DNA reports, identification of CMV reactivation, and confirmation of treatment response; JJ Zhu, MM Xu, YH Ru, and HL Gong: data acquisition, analysis, and interpretation. JJ Zhu and MM Xu drafted the article. TM Song, J Chen, and DP Wu: critical revision of the manuscript for important intellectual content, and final approval for submission. The other authors: patient management and data acquisition. All authors have read and agreed to the published version of the manuscript.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors.

Additional information

Funding

Link not available for ‘National Key R&D Program of China (2022YFC2502700); National Natural Science Foundation of China (82370215, 82200237, 82300250, and 82020108003); Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD); Jiangsu Provincial Medical Innovation Center (CXZX202201); Natural Science Foundation of Jiangsu Province (BK20220246); Suzhou Science and Technology Program Project’ funding details. Please check.

This research was funded by National Key R&D Program of China (2022YFC2502700); National Natural Science Foundation of China (82370215, 82200237, 82300250, and 82020108003); Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD); Jiangsu Provincial Medical Innovation Center (CXZX202201); Natural Science Foundation of Jiangsu Province (BK20220246); Suzhou Science and Technology Program Project (SKY2023047, SKY2021039, and SKY2022132).