Adenovirus infection in adult patients undergoing allogeneic hematopoietic stem cell transplant: Incidence, clinical management, and outcome.
Adenovirus
allogeneic hematopoietic stem cell transplant
immunocompromised
screening
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
08 Jan 2024
08 Jan 2024
Historique:
revised:
28
11
2023
received:
06
10
2023
accepted:
02
12
2023
medline:
9
1
2024
pubmed:
9
1
2024
entrez:
9
1
2024
Statut:
aheadofprint
Résumé
Adenovirus infection (ADVi) is an emergent complication in adult patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with poor outcome. Available data on risk factors and optimal management of ADVi in adult allo-HSCT recipients are limited, and recommendations on monitoring and pre-emptive therapy are mainly based on pediatric data. In this single-center, retrospective study, we reported all cases of positive ADV-DNA from adult patients undergoing allo-HSCT in the period 2014-2019. The study aimed to describe the incidence of ADVi at day +180 post-transplant. Secondly to describe timing, clinical presentation, risk factors, and outcome of ADVi and to analyze the application of a screening strategy in our cohort. In 445 allo-HSCT recipients, the day +180 incidence was: 9% (39/445) for ADVi, 5% (24/445) for ADV viremia (ADVv), and 3% (15/445) for localized ADVi. The median time to ADVi was 65 (IQR 19; 94) days after HSCT. ADVv-related mortality was 13% (3/24), all cases occurring with blood max-ADV-DNA > 10^3 cp/mL. Independent risk factors for ADVi were diagnosis of lymphoproliferative disease (p = .011) and acute graft-versus-host-disease (p = .021). In our cohort, ADVi and ADVv were more frequent than previously reported. ADVv with max-ADV-DNA > 10^3 cp/mL was associated with ADV-related mortality, thus careful monitoring and early initiation of treatment are advisable.
Sections du résumé
BACKGROUND
BACKGROUND
Adenovirus infection (ADVi) is an emergent complication in adult patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with poor outcome. Available data on risk factors and optimal management of ADVi in adult allo-HSCT recipients are limited, and recommendations on monitoring and pre-emptive therapy are mainly based on pediatric data.
METHODS
METHODS
In this single-center, retrospective study, we reported all cases of positive ADV-DNA from adult patients undergoing allo-HSCT in the period 2014-2019. The study aimed to describe the incidence of ADVi at day +180 post-transplant. Secondly to describe timing, clinical presentation, risk factors, and outcome of ADVi and to analyze the application of a screening strategy in our cohort.
RESULTS
RESULTS
In 445 allo-HSCT recipients, the day +180 incidence was: 9% (39/445) for ADVi, 5% (24/445) for ADV viremia (ADVv), and 3% (15/445) for localized ADVi. The median time to ADVi was 65 (IQR 19; 94) days after HSCT. ADVv-related mortality was 13% (3/24), all cases occurring with blood max-ADV-DNA > 10^3 cp/mL. Independent risk factors for ADVi were diagnosis of lymphoproliferative disease (p = .011) and acute graft-versus-host-disease (p = .021).
CONCLUSIONS
CONCLUSIONS
In our cohort, ADVi and ADVv were more frequent than previously reported. ADVv with max-ADV-DNA > 10^3 cp/mL was associated with ADV-related mortality, thus careful monitoring and early initiation of treatment are advisable.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14215Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Matthes-Martin S, Feuchtinger T, Shaw PJ, et al. European guidelines for diagnosis and treatment of adenovirus infection in leukemia and stem cell transplantation: summary of ECIL-4 (2011). Transpl Infect Dis. 2012;14(6):555-563.
Sedlacek P, Petterson T, Robin M, et al. Incidence of adenovirus infection in hematopoietic stem cell transplantation recipients: findings from the AdVance study. Biol Blood Marrow Transplant. 2019;25(4):810-818.
Papanicolaou GA, Dvorak CC, Dadwal S, et al. Practice patterns and incidence of adenovirus infection in allogeneic hematopoietic cell transplant recipients: multicenter survey of transplant centers in the United States. Transpl Infect Dis. 2020;22(4):e13283.
Cesaro S, Berger M, Tridello G, et al. A survey on incidence and management of adenovirus infection after allogeneic HSCT. Bone Marrow Transplant. 2019;54(8):1275-1280.
Czyzewski K, Styczynski J, Giebel S, et al. Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation: lesson from the nationwide study. Ann Hematol. 2019;98(9):2197-2211.
La Rosa AM, Champlin RE, Mirza N, et al. Adenovirus infections in adult recipients of blood and marrow transplants. Clin Infect Dis. 2001;32(6):871-876.
Lion T. Adenovirus infections in immunocompetent and immunocompromised patients. Clin Microbiol Rev. 2014;27(3):441-462.
Bil-Lula I, Ussowicz M, Rybka B, et al. PCR diagnostics and monitoring of adenoviral infections in hematopoietic stem cell transplantation recipients. Arch Virol. 2010;155(12):2007-2015.
Kampmann B, Cubitt D, Walls T, et al. Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation. Br J Haematol. 2005;130(4):595-603.
Ramsay ID, Attwood C, Irish D, Griffiths PD, Kyriakou C, Lowe DM. Disseminated adenovirus infection after allogeneic stem cell transplant and the potential role of brincidofovir - case series and 10 year experience of management in an adult transplant cohort. J Clin Virol. 2017;96:73-79.
Ehlert K, Schulte JH, Kuhl JS, Lang P, Eggert A, Voigt S. Efficacy of brincidofovir in pediatric stem cell transplant recipients with adenovirus infections. J Pediatric Infect Dis Soc. 2021;10(11):987-993.
Wiriyachai T, Chaya W, Anurathapan U, et al. Association between adenovirus infection and mortality outcome among pediatric patients after hematopoietic stem cell transplant. Transpl Infect Dis. 2021;23(6):e13742.
Peker BO, Tuysuz Kintrup G, Saglik I, et al. Follow-up of human adenovirus viral load in pediatric hematopoietic stem cell transplant recipients. Clin Transplant. 2021;35(3):e14209.
Deambrosis D, Davies E, Turner A, et al. Burden of adenoviraemia predicts survival in paediatric recipients of allogeneic haematopoietic stem cell transplant. J Clin Virol. 2020;127:104373.
Feghoul L, Chevret S, Cuinet A, et al. Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment. Clin Microbiol Infect. 2015;21(7):701-709.
Hiwarkar P, Gaspar HB, Gilmour K, et al. Impact of viral reactivations in the era of pre-emptive antiviral drug therapy following allogeneic haematopoietic SCT in paediatric recipients. Bone Marrow Transplant. 2013;48(6):803-808.
Chakrabarti S, Mautner V, Osman H, et al. Adenovirus infections following allogeneic stem cell transplantation: incidence and outcome in relation to graft manipulation, immunosuppression, and immune recovery. Blood. 2002;100(5):1619-1627.
Hubmann M, Fritsch S, Zoellner AK, et al. Occurrence, risk factors and outcome of adenovirus infection in adult recipients of allogeneic hematopoietic stem cell transplantation. J Clin Virol. 2016;82:33-40.
Hiwarkar P, Kosulin K, Cesaro S, et al. Management of adenovirus infection in patients after haematopoietic stem cell transplantation: state-of-the-art and real-life current approach: a position statement on behalf of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation. Rev Med Virol. 2018;28(3):e1980.
Kerbauy MN, Ribeiro AAF, Arcuri LJ, et al. Clinical impact of multiple DNA virus infections in nondepleted haploidentical and unrelated allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis. 2021;23(4):e13626.
Mehta RS, Saliba RM, Rondon G, et al. Post-transplantation cyclophosphamide versus tacrolimus and methotrexate graft-versus-host disease prophylaxis for HLA-matched donor transplantation. Transplant Cell Ther. 2022;28(10):695. e1-e10.
Lion T. Adenovirus persistence, reactivation, and clinical management. FEBS Lett. 2019;593(24):3571-3582.