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Haematopoietic Stem Cell TransplantationCIRCLENCT07915505

Specific Immune Reconstitution After Allogeneic Transplantation and Letermovir Prophylaxis

A study testing Letermovir and Comparator in people with Haematopoietic Stem Cell Transplantation and Antivirals, run by University Hospital, Limoges at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Cytomegalovirus (CMV) is a major cause of morbidity in hematopoietic stem cell transplant recipients, with both direct effects, including CMV disease, and indirect effects, such as graft-versus-host disease (GVHD) and increased immunosuppression. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Letermovir and Comparator
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteFrance
Study dates
6 Sep 2022to 13 Oct 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • CMV-seropositive patient included in the NAViRe cohort. Patient having signed a specific consent for the CIRCLE study.

Who cannot join

  • Patient not included or not includible in the NAViRe cohort. Patient included in the NAViRe cohort but who refused the Circle protocol.

Trial locations and contacts

1 site in 1 country.

France1 site
  • Chu Limoges

    Limoges, 87042

Other trials in France

About this study

Official title: Specific Immune Reconstitution After Allogeneic Transplantation in Case of Preventive Anti-CMV Treatment With Letermovir.

Cytomegalovirus (CMV) is a major cause of morbidity in hematopoietic stem cell transplant recipients, with both direct effects, including CMV disease, and indirect effects, such as graft-versus-host disease (GVHD) and increased immunosuppression.

Virological monitoring and preemptive treatment with ganciclovir have reduced the incidence of CMV disease from approximately 30% to 2-6%, but have not eliminated the indirect morbidity associated with viral replication. Letermovir, a non-hematotoxic antiviral agent targeting the CMV terminase complex, has demonstrated efficacy in preventing CMV infection in this population.

The CIRCLE study aims to describe the evolution of global and CMV-specific immune reconstitution in CMV-seropositive hematopoietic stem cell transplant recipients receiving or not receiving letermovir prophylaxis, and to characterize the immune response over time.

Read the detailed description

Cytomegalovirus (CMV) remains an important cause of morbidity in hematopoietic stem cell transplant recipients. Its effects include direct complications, such as CMV disease, and indirect complications, including graft-versus-host disease (GVHD) and increased immunosuppression.

Virological monitoring and preemptive treatment with ganciclovir have reduced the incidence of CMV disease from approximately 30% to 2-6%, but have not eliminated the indirect morbidity associated with viral replication. Before the availability of preventive treatment, CMV-related complications represented a substantial burden and were associated with an additional cost estimated at 25-30% of the total cost of transplantation (Robin et al., 2017).

Letermovir, an antiviral agent targeting the CMV terminase complex, has demonstrated efficacy as prophylaxis against CMV infection in hematopoietic stem cell transplant recipients (Marty et al., 2017). However, immune reconstitution during prophylaxis, which may help inform the duration of preventive treatment, requires further investigation. Previous publications have suggested a delay in CMV-specific immune reconstitution, but a comprehensive assessment of the immune response remains necessary.

The CIRCLE study is a prospective, multicenter ancillary study of the French NaViRe cohort (NCT04690933). It aims to describe global and CMV-specific immune reconstitution over time in CMV-seropositive hematopoietic stem cell transplant recipients receiving or not receiving letermovir prophylaxis. The study uses research and commercial assays to characterize immune responses and explore their potential relevance to routine patient monitoring.

A total of 50 patients are planned for inclusion: 25 receiving letermovir prophylaxis and 25 not receiving letermovir prophylaxis. Immune responses will be evaluated using immunological and virological assessments during follow-up after transplantation, including assessments up to 12 months after transplantation.

Being tested
Letermovir, Comparator
Keywords
Cytomegalovirus, Immune reconstitution, Letermovir, Stem Cell Transplantation
Medical subject headings
Cytomegalovirus Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LetermovirDrug

    Letermovir administered as primary prophylaxis against cytomegalovirus infection in CMV-seropositive hematopoietic stem cell transplant recipients, according to standard clinical practice.

  • ComparatorOther

    CMV-seropositive hematopoietic stem cell transplant recipients included in the Cryostem cohort who did not receive letermovir as primary prophylaxis.

Study groups in NCT07915505
Study groupRoleWhat they receive
Patients receiving letermovir prophylaxisExperimentalCMV-seropositive hematopoietic stem cell transplant recipients receiving letermovir as primary prophylaxis and included in the NAViRe cohort. The study will describe overall and CMV-specific immune reconstitution, including its evolution during follow-up, using immunological and virological assessments.
Receives: Drug: Letermovir
Patients not receiving letermovir prophylaxisOtherObservational Cohort. CMV-seropositive hematopoietic stem cell transplant recipients included in the Cryostem cohort who did not receive letermovir as primary prophylaxis. The study will describe overall and CMV-specific immune reconstitution, including assessments before transplantation and at day 100 after transplantation.
Receives: Other: Comparator

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Viral load of torque teno virus (TTV) in whole blood

    TTV viral load measured in whole blood and reported as copies/mL.

    Measured: Before transplantation (Day -30 to Day -8), Day 20, Month 3, Month 6, and Month 12 after transplantation.

  2. Qualitative and functional assessment of natural killer (NK) cells

    Qualitative and functional analysis of NK cells and measurement of CD74 RNA expression.

    Measured: Before transplantation (Day -30 to Day -8) and Day 100 after transplantation in patients not receiving letermovir prophylaxis.

  3. CMV-specific cellular immune response

    CMV-specific cellular immune response measured using QuantiFERON-CMV, ELISpot-CMV, and flow cytometry to quantify CMV-specific alpha-beta and gamma-delta T cells, including intracellular cytokine production and PD-1 receptor expression.

    Measured: Before transplantation (Day -30 to Day -8), Day 20, Month 3, Month 6, and one month after the end of letermovir prophylaxis, as applicable. An additional assessment will be performed one month after CMV reactivation, if applicable.

  4. CMV-specific IgG concentration in plasma

    Quantification of CMV-specific IgG antibodies in plasma.

    Measured: Before transplantation (Day -30 to Day -8), Day 20, Month 3, Month 6, and one month after the end of letermovir prophylaxis, as applicable.

  5. Time to development of a significant CMV-specific cellular immune response

    Time from transplantation to the first significant CMV-specific cellular immune response, defined by a positive QuantiFERON-CMV or ELISpot-CMV result according to the manufacturer's cut-offs, or detection of a CMV-specific T-cell response by flow cytometry following stimulation with CMV antigens.

    Measured: From before transplantation (Day -30 to Day -8) through Month 12 after transplantation.

  6. Number of participants with CMV infection

    Number of participants with CMV infection, defined by a positive diagnostic test for CMV detection without clinical symptoms.

    Measured: From before transplantation (Day -30 to Day -8) through Month 24 after transplantation.

  7. Number of participants with CMV disease

    Number of participants with CMV disease, defined as CMV infection associated with clinical symptoms and organ involvement.

    Measured: From before transplantation (Day -30 to Day -8) through Month 24 after transplantation.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Nov 2026
  2. Study start6 Sep 2022
  3. Primary completion13 Apr 2026
  4. Study completion13 Oct 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Not applicable
Intervention model
Single group
Model description
Describe immune reconstitution global and anti-Cytomegalovirus in CMV-seropositive hematopoietic stem cell recipients as a factor of letermovir prophylaxis administration and duration
Masking
None (open label)
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07915505
Sponsor's protocol ID
87RI19_0024_CIRCLE
Acronym
CIRCLE
Status last verified
Sep 2022
First submitted
2 Sep 2022
Last updated
4 Nov 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Chemaly RF, Chou S, Einsele H, Griffiths P, Avery R, Razonable RR, Mullane KM, Kotton C, Lundgren J, Komatsu TE, Lischka P, Josephson F, Douglas CM, Umeh O, Miller V, Ljungman P; Resistant Definitions Working Group of the Cytomegalovirus Drug Development Forum. Definitions of Resistant and Refractory Cytomegalovirus Infection and Disease in Transplant Recipients for Use in Clinical Trials. Clin Infect Dis. 2019 Apr 8;68(8):1420-1426. doi: 10.1093/cid/ciy696.

    PubMed 30137245
  • Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, Humar A; The Transplantation Society International CMV Consensus Group. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018 Jun;102(6):900-931. doi: 10.1097/TP.0000000000002191.

    PubMed 29596116
  • Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G, Pikis A, Razonable RR, Miller V, Griffiths PD; Disease Definitions Working Group of the Cytomegalovirus Drug Development Forum. Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin Infect Dis. 2017 Jan 1;64(1):87-91. doi: 10.1093/cid/ciw668. Epub 2016 Sep 28.

    PubMed 27682069
  • Marty FM, Ljungman P, Chemaly RF, Maertens J, Dadwal SS, Duarte RF, Haider S, Ullmann AJ, Katayama Y, Brown J, Mullane KM, Boeckh M, Blumberg EA, Einsele H, Snydman DR, Kanda Y, DiNubile MJ, Teal VL, Wan H, Murata Y, Kartsonis NA, Leavitt RY, Badshah C. 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.

    PubMed 29211658
  • Robin C, Hemery F, Dindorf C, Thillard J, Cabanne L, Redjoul R, Beckerich F, Rodriguez C, Pautas C, Toma A, Maury S, Durand-Zaleski I, Cordonnier C. Economic burden of preemptive treatment of CMV infection after allogeneic stem cell transplantation: a retrospective study of 208 consecutive patients. BMC Infect Dis. 2017 Dec 5;17(1):747. doi: 10.1186/s12879-017-2854-2.

    PubMed 29207952

Questions about this trial

What is this clinical trial studying?

A study testing Letermovir and Comparator in people with Haematopoietic Stem Cell Transplantation and Antivirals, run by University Hospital, Limoges at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Viral load of torque teno virus (TTV) in whole blood (time frame: Before transplantation (Day -30 to Day -8), Day 20, Month 3, Month 6, and Month 12 after transplantation.). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07915505, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Nov 2026.

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