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Guidelines

Guidelines

In the ECIL-10 guidelines Letermovir is recommended as the strategy of choice for preventing CMV for CMV primary prophylaxis for CMV seropositive adult allo-HSCT recipients. It is recommended to start as early after allo-HSCT as feasible to reduce the risk of early reactivations but no later than day 28 post-transplantation. Prophylaxis should be continued through at least 100 days post-HSCT. Extended prophylaxis should be considered in patients at high risk for CMV disease and can continue to at least 200 days after transplantation.1,2

Letermovir is in the ECIL-10 guidelines the only agent with a grade A1 recommendation for antiviral prophylaxis in adults.1,2

The ECIL-10 guidelines recommendation is based on results of the phase 3 trial [Marty et al. 20173], which found that PREVYMIS® vs placebo, through Week 24:

reduced csCMVi - icon

Significantly reduced csCMVi

all-cause mortality

Was associated with lower all-cause mortality

placebo - icon

Demonstrated discontinuation rates similar to placebo1

Strength of recommendation

Grade A

Strongly supports the recommendation for use

Grade B

Moderately supports the recommendation for use

Grade C

Marginally supports the recommendation for use

Grade D

Not recommended

Quality of evidence

Level I

Evidence from at least one properly designed randomized, controlled trial

Level II*

Evidence from at least one well-designed clinical trial, without randomization; from cohort or case-controlled analytical studies (preferably from > 1 center); from multiple time series; or from dramatic results of uncontrolled experiments

Level III

Evidence from opinions of respected authorities, based on clinical experience, descriptive case studies, or reports of expert committees

*Added index for level Il quality of evidence:
r: Meta-analysis or systematic review of randomized controlled trials.
t: Transferred evidence, that is, results from different patient cohorts, or similar immune-status situation.
h: Comparator group is a historical control.
u: Uncontrolled trial.
a: Published abstract (presented at an international symposium or meeting).

Recommendations are based on the grading system of the European Society of Clinical Microbiology and Infectious Disease (ESCMID).


At the 51st Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT) in Florence, Italy, Dr. Per Ljungman from Karolinska Institute presented an overview of the updated ECIL-10 guidelines for managing cytomegalovirus (CMV) in immunocompromised patients. In a post-EBMT webcast, supported by MSD as a gold sponsor, he highlighted evidence-based recommendations for CMV prevention, monitoring, and treatment—including the use of letermovir for antiviral prophylaxis.

References:
  1. Ljungman P et al2017 European Conference on Infections in Leukaemia group. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019 Aug;19(8):e260-e272.
  2. Ljungman Pet al., Recommendations from the 10th European Conference on Infections in Leukaemia for the management of cytomegalovirus in patients after allogeneic haematopoietic cell transplantation and other T-cell-engaging therapies. Lancet Infect Dis. 2025 Apr 3:S1473-3099(25)00069-6.
  3. Marty FM et al., Letermovir Prophylaxis for Cytomegalovirus in Hematopoietic-Cell Transplantation. N Engl J Med. 2017 Dec 21;377(25):2433-2444. doi: 10.1056/NEJMoa1706640. Epub 2017 Dec 6. PMID: 29211658.