Incidence of Adenovirus Infection in Hematopoietic Stem Cell Transplantation Recipients: Findings from the AdVance Study

Abstract

Adenovirus (AdV) is an increasingly recognized threat to recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT), particularly when infection is prolonged and unresolved. AdVance is the first multinational, multicenter study to evaluate the incidence of AdV infection in both pediatric and adult allo-HCT recipients across European transplantation centers. Medical records for patients undergoing first allo-HCT between January 2013 and September 2015 at 50 participating centers were reviewed. The cumulative incidence of AdV infection (in any sample using any assay) during the 6 months after allo-HCT was 32% (95% confidence interval [CI], 30.9% to 33.4%) among pediatric allo-HCT recipients (n = 1736) and 6% (95% CI, 4.7% to 6.4%) among adult allo-HCT recipients (n = 2540). The incidence of AdV viremia 1000 copies/mL (a common threshold for initiation of preemptive treatment) was 14% (95% CI, 13.0% to 14.8%) in pediatric recipients and 1.5% (95% CI, 1.1% to 2.0%) in adult recipients. Baseline risk factors for developing AdV viremia 1000 copies/mL included younger age, use of T cell depletion, and donor type other than matched related. Baseline demographic factors were broadly comparable across patients of all ages and identified by multivariate analyses. Notably, the incidence of AdV infection decreased stepwise with increasing age; younger adults (age 18 to 34 years) had a similar incidence as older pediatric patients (<18 years). This study provides a contemporary multicenter understanding of the incidence and risk factors for AdV infection following allo-HCT. Our findings may help optimize infection screening and intervention criteria, particularly for younger at-risk adults.

Multiple strictures of the small intestine demanding surgical intervention as a rare consequence of graft versus host disease – case report

“…Gavel et al [6] reported a case of a child with GvHD and subsequent bowel obstruction who had a history of CMV and ADV reactivation in the posttransplant period. ADV infection occurs in 32% of pediatric and 6% of adult transplant recipients [7]. Cidofovir is the most used antiviral therapy [8] in ADV reactivation, but it was not effective in our patient.…”

Virus-specific T cells in pediatric renal transplantation

“…ADV infections are not uncommon after pediatric kidney transplantation but seldom lead to clinical problems [43][44][45][46], whereas morbidity is much higher after stem cell transplantation [47]. There are only a few studies available concerning ADV-specific T cells after solid organ transplantation.…”

Adoptive T Cell Therapy Strategies for Viral Infections in Patients Receiving Haematopoietic Stem Cell Transplantation

“…Although some patients remain asymptomatic and clear the virus spontaneously, others can present with rapid progression to fatal multiorgan failure. The incidence of AdV viremia following HSCT is higher in paediatric patients, with a significantly higher mortality for patients developing AdV disease [5]. Clinical manifestations include haemorrhagic enteritis or cystitis, pneumonia, hepatitis, encephalitis and multiorgan failure [6].…”