1. Occurrence, risk factors and outcome of adenovirus infection in adult recipients of allogeneic hematopoietic stem cell transplantation
- Author
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Johanna Tischer, Andreas Moosmann, Friederike Mumm, Dusan Prevalsek, Wolfgang Hiddemann, Nicole Engel, Christoph Schulz, Max Hubmann, Veit Bücklein, Hans-Jochem Kolb, Georg Ledderose, Susanne Fritsch, Hans Joachim Stemmler, Anna-Katharina Zoellner, Andreas Hausmann, and Gundula Jäger
- Subjects
Adult ,Male ,endocrine system ,medicine.medical_specialty ,Adolescent ,Cyclophosphamide ,Adenoviridae Infections ,animal diseases ,viruses ,medicine.medical_treatment ,Hematopoietic stem cell transplantation ,Antiviral Agents ,Immunocompromised Host ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Virology ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Disseminated disease ,Adenovirus infection ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,Hematopoietic Stem Cell Transplantation ,virus diseases ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Hematologic Diseases ,Survival Analysis ,Transplantation ,Pneumonia ,Treatment Outcome ,Infectious Diseases ,030220 oncology & carcinogenesis ,Immunology ,Female ,business ,030215 immunology ,medicine.drug - Abstract
Background Adenovirus (ADV) infections can have a high mortality in immunocompromised patients and are difficult to treat. Objectives and study design We retrospectively analyzed occurrence and risk factors of ADV infection in 399 adults with hematological disorders undergoing hematopoietic stem cell transplantation (allo-HSCT), focusing on alternative donor transplantation (ADT) and disseminated disease. Results ADV infection occurred in 42 patients (10.5%). Disease was localized in 18 and disseminated in 6 patients. ADV infection was observed in 15% after ADT, performed in 29% of all recipients, and was less frequent (6%) in T-cell-replete (TCR) haploidentical transplantation using post-transplantation cyclophosphamide (PTCY) than in other ADT protocols. Lower age, the use of alternative donor grafts and acute graft-versus-host disease (GvHD) ≥ grade II were risk factors for ADV infection. After failure of standard antiviral treatment, three patients with disseminated ADV disease received one dose of ADV-specific T cells, resulting in virological response in 2/3 patients, clearance of ADV viremia in 2/2 patients, and survival of 1/3 patients; both patients with pneumonia died. Conclusions ADV infection was of moderate occurrence in our adult recipients of allo-HSCT despite a high proportion of potential high-risk patients receiving ADT. TCR strategies using PTCY might limit ADV complications in haploidentical transplantation. Despite feasible adoptive therapy strategies, outcome of disseminated disease remains dismal.
- Published
- 2016