Letermovir for the Prevention of Cytomegalovirus Reactivation in Patients with Non-Hodgkin Lymphoma after CAR T Cell Therapy
This clinical trial tests how well letermovir works in preventing cytomegalovirus (CMV) reactivation in patients with non-Hodgkin lymphoma after chimeric antigen receptor (CAR) T cell therapy with axicabtagene ciloleucel (AXI-CEL). Letermovir is in a class of medications called antivirals. It works by slowing the growth of CMV. Approximately 83% of the world’s population have been infected by CMV. In healthy humans, CMV is controlled by the immune system which prevents the development of clinically significant infection, including end organ disease. Patients who have a suppressed immune system, such as those who have received lymphodepleting and immunosuppressive chemotherapy prior to CAR T cell therapy, may be at increased risk for CMV reactivation. CMV reactivation in CMV positive patients by 100 days after CAR T cell therapy is 44% and preventative strategies to prevent CMV reactivation after CAR T cell therapy are not clear. CMV reactivation can cause a CMV blood infection. If untreated, the CMV blood infection can extend to solid organs, such as the lungs, intestines, liver, and retina, resulting in CMV organ disease. CMV organ disease is associated with a high rate of mortality and morbidity. Thus, prevention of CMV reactivation is a clinical priority in immunosuppressed at risk populations. Giving letermovir may be an effective preventative strategy for the prevention of CMV reactivation after CAR T cell therapy.