Increasing Incidence of Adenovirus Disease in Bone Marrow Transplant Recipients

Abstract

Adenovirus infections in 201 bone marrow transplant (BMT) recipients over 4 years were retrospectively reviewed. Forty-two patients (20.9%) had positive adenovirus cultures after BMT. There was a higher incidence of adenovirus infections in pediatric patients than in adults (31.3% vs. 13.6%, P = .003). In addition, the time of onset of adenovirus infection after transplant was earlier in pediatric patients (mean, < 30 days) than in adults (> 90 days). Adenovirus type 35 was the most common serotype identified. One-third of adenovirus-positive patients had definite or probable adenovirus disease. Moderate to severe acute graft-versus-host disease and isolation of adenovirus from two or more sites were significant risk factors for adenovirus disease. This report documents a higher incidence of both adenovirus infection and disease than do previous studies. Adenovirus may emerge as a more frequent pathogen as more high-risk BMT transplants are done.

A Rare Case of Hemorrhagic Cystitis in Allogeneic Hematopoietic Stem Cell Transplant Patient

“…Commonly, adenovirus infection has been documented in the first 100 days of post-BMT period [5,6]. However, like our case, there are reports when patients have acquired adenovirus infection after 100 days post-BMT [7]. Regarding the associated risk factors involved in acquiring adenovirus infections are type of transplant (allogeneic vs autologous), history of aGVHD, use of immunosuppressive drugs, use of conditioning regimen containing cyclophosphamide, fludarabine or TBI, younger age group, asymptomatic viremia, unrelated donor, adenovirus antibody status of donor, T cell depletion of stem cell harvest [6,[8][9][10][11].…”

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

“…Subsequently, newfound awareness of AdV may have led to more intense surveillance strategies reinforced by the application of new sensitive methods for molecular diagnosis. Several risk factors for AdV infection have been identified with different levels of effect on incidence: younger age, 5,[23][24][25] usage of T cell-depleted grafts, 13,26,27 grafts from an unrelated donor, 23 GVHD or its therapy 28 and a slow lymphocyte recovery. 13,27 In particular, transplantation of CD34 þ selected grafts were related to an increased incidence of AdV infection.…”

“…9,11,26,31 It would therefore be logical to identify what group of patients to screen and in what period after HSCT. As adults seem to get their AdV infection later in the post transplantation period, and the risk for AdV disease seems to be low, 25 a sampling schedule parallel to CMV screening may not be adequate. In contrast, children often get their AdV infection within 30 days after transplantation, 25 and treatment with cidofovir in this patient group has in most published reports been shown to be efficient and often without unacceptable side effects.…”

Adenovirus hexon T-cell epitope is recognized by most adults and is restricted by HLA DP4, the most common class II allele

“…Ad-specific T cells are crucial for recovery from natural Ad infections, because infections are more severe and sometimes fatal in patients with cellular immune dysfunction. 4,5 We previously documented the presence of virus-specific proliferative T-cell responses in peripheral blood mononuclear cells (PBMC) from nearly all healthy adults. 6 Moreover, in contrast to serotype-specific neutralizing antibodies, we detected Tcell responses that cross-react between serotypes.…”