Evaluation of a surveillance strategy for early detection of adenovirus by PCR of peripheral blood in hematopoietic SCT recipients: incidence and outcome

Abstract

Adenoviruses (AdV) have emerged as important causes of morbidity and mortality in patients after hematopoietic SCT (HSCT). Early diagnosis of the infection by detection of viral DNA may improve the prognosis. A surveillance strategy was evaluated for detection of AdV DNA by PCR in a prospective study of unselected allogeneic HSCT recipients. In parallel with a routine CMV surveillance program, plasma from 20 children and 77 adults was analyzed by quantitative PCR for detection of AdV DNA. In addition, in 12 unselected patients, the presence of AdV-specific T cells were analyzed by enzyme-linked immunosorbent spot (ELISPOT) at 1 to 3 months after transplantation. A total of 5 of 97 (5%) patients had detectable AdV DNA in peripheral blood. Only one patient had high titers and none developed AdV disease. BM as a source of stem cells and myelodysplastic syndrome as the indication for transplantation were independently associated with higher risk of acquiring AdV infection. AdV-specific T cells were detected in 7 (58%) of 12 patients. Although AdV DNA was found in peripheral blood by quantitative PCR in 5% of patients undergoing allogeneic HSCT, the present surveillance program did not have a significant effect on the clinical outcome.

Incidence of Adenoviral DNAemia in Polish Adults Undergoing Allogeneic Haematopoietic Stem Cell Transplantation

“…Following HSCT, immunological responses to HAdV are poor; hence serological diagnosis is not reliable. Molecular identification of HAdV infection with PCR facilitates accurate and rapid diagnosis and can be used also for surveillance (Bil-Lula et al 2010;Ö hrmalm et al 2011). Weekly monitoring of different fluids of transplant recipients for active HAdV infection by real-time PCR (qPCR) could potentially be applied in HSCT recipients (Bil-Lula et al 2010;Matthes-Martin et al 2012).…”

Human parvovirus B19 in pediatric and adult recipients of allogeneic hematopoietic stem cell transplantation

“…In a prospective longitudinal study of 20 pediatric and 77 adult HSCT recipients, we evaluated the benefit of screening for AdV in parallel to a routine CMV surveillance program. 5 Both plasma and serum samples were collected weekly during the first 9 weeks after HSCT and at followup visits approximately 3, 6, and 12 months later. Whereas the plasma samples were used for detection of AdV DNA, the serum samples were used for detection of B19 DNA by a PCR method.…”

Surveillance for adenovirus DNAemia early after transplantation in adult recipients of unrelated-donor allogeneic stem cell transplants in the absence of clinically suspected infection

“…3,5,7 The null incidence of AdV DNAemia in our series was somewhat unexpected given the clinical characteristics of the patients. A role of ganciclovir in the prophylaxis of AdV infections in allo-SCT recipients has been proposed on the basis of clinical and in vitro activity data.…”

“…In addition, AdV DNAemia may occur late after transplantation, beyond the time frame investigated in this study. 5 It is also possible that the number of specimens analyzed per patient may have been insufficient to detect transient self-resolved episodes of AdV DNAemia. Nevertheless, in support of our data, Gustafson et al, 9 failed to detect AdV DNA in sequential plasma specimens drawn up to 6 months after transplantation from patients with no signs of AdV infection who underwent unrelated-donor allo-SCT and were treated with T-cell depleting agents at the time of transplantation.…”