Real-World Experience With Maribavir for Treatment of Refractory or Resistant Cytomegalovirus Infection in Hematopoietic Cell Transplant Recipients and Hematologic Malignancy Patients.

Background: Refractory and/or resistant (R/R) cytomegalovirus (CMV) infection is a serious complication after allogeneic hematopoietic cell transplantation (HCT). Maribavir, an oral antiviral agent, was approved in November 2021 for the treatment of R/R CMV in transplant recipients. However, real-world data on the use of maribavir in HCT recipients and hematologic malignancy (HM) patients are limited. We described our early experience with the use of maribavir in the year after its Food and Drug Administration approval in HCT recipients and HM patients.

Methods: We performed a retrospective study of all patients who received maribavir for treatment of CMV infection at our center from November 2021 to December 2022. Clinical characteristics and outcomes of CMV infection were collected for each case. Descriptive statistics were calculated.

Results: Our study included 13 patients (11 of whom were HCT recipients and two with HM) who received a median of 58 days of maribavir therapy. While on maribavir, nine (69%) patients had a resolution of CMV infection. Treatment-emergent maribavir resistance was documented in one patient with a CMV UL97 C480F mutation. Patients with higher baseline viral loads were less likely to achieve CMV resolution compared to those with lower levels. Additionally, six patients received combination therapy with maribavir. Six patients developed dysgeusia, none requiring maribavir discontinuation.

Conclusion: Maribavir is an effective and safe option for the treatment of R/R CMV infections in HCT recipients and HM patients. Our study highlights the complexities of managing CMV infections in this patient population and some challenges associated with maribavir therapy.