{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:56:56Z","timestamp":1785373016248,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cytomegalovirus (CMV) is associated with detrimental outcomes after lung transplantation (LTX); primary prophylaxis (PPX) with valganciclovir (VGC) is guideline\u2010recommended. VGC is associated with myelosuppression, spurring interest in letermovir (LTV).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults undergoing LTX between January 1, 2021, and July 30, 2022 at our institution who were converted from VGC to LTV for PPX were evaluated. Outcomes included antimetabolite dosing during PPX, the incidence and frequency of myelosuppressive events, and the time to the first myelosuppressive event.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010nine LTX recipients met the inclusion criteria. Most patients received non\u2010lymphocyte\u2010depleting induction (96.6%) and had moderate risk CMV serostatus (D+\/R+, 48.3%). Patients transitioned from VGC to LTV 177 days (IQR 102 days) post\u2010transplant. After conversion to LTV, patients tolerated higher daily doses of mycophenolate (721\u00a0mg vs. 1000\u00a0mg, <jats:italic>p<\/jats:italic> = 0.008) or azathioprine (33.3\u00a0mg vs. 62.5\u00a0mg, <jats:italic>p<\/jats:italic> = 0.478). The incidence of myelosuppressive events was reduced (100.0%\u00a0vs. 62.1%, <jats:italic>p<\/jats:italic> &lt; 0.001) including leukopenia (96.6%\u00a0vs. 58.6%, <jats:italic>p<\/jats:italic> = 0.001), severe leukopenia (82.8%\u00a0vs 31.0%, <jats:italic>p<\/jats:italic> &lt; 0.001) and neutropenia requiring GCSF (96.6%\u00a0vs. 48.3%, <jats:italic>p<\/jats:italic> &lt; 0.001) while on VGC compared to LTV. While on LTV, patients had a reduced rate of myelosuppressive events compared to VGC (1 event per 6.2 patient days vs. 1 event per 14.7 patient days, <jats:italic>p<\/jats:italic> &lt; 0.001). While on LTV, one patient had breakthrough viremia (3.4%) that was treated with (val)ganciclovir.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this single\u2010center study, patients tolerated higher doses of antimetabolite immunosuppression, and the incidence and frequency of myelosuppressive events were reduced while on LTV compared to VGC. This evidence expands upon the current literature demonstrating improved tolerability of LTV in LTX recipients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70033","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T11:09:46Z","timestamp":1732705786000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Letermovir for Cytomegalovirus Primary Prophylaxis on Myelosuppression and Immunosuppression in Lung Transplant Recipients"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3149-6558","authenticated-orcid":false,"given":"Hanna L.","family":"Kleiboeker","sequence":"first","affiliation":[{"name":"Department of Pharmacy Northwestern Memorial Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyson","family":"Prom","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Northwestern Memorial Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3115-1210","authenticated-orcid":false,"given":"Krista","family":"Paplaczyk","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Northwestern Memorial Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Wang","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Borkowski","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Canning Thoracic Institute Northwestern Memorial Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"Miner","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Canning Thoracic Institute Northwestern Memorial Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Wright","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Canning Thoracic Institute Northwestern Memorial Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrinalini","family":"Venkata Subramani","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambalavanan","family":"Arunachalam","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan D.","family":"Betensley","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rade","family":"Tomic","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine N.","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Northwestern University Feinberg School of Medicine  Chicago Illinois 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