Invasive adenoviral infections in T-cell-depleted allogeneic hematopoietic stem cell transplantation: high mortality in the era of cidofovir
Article first published online: 30 JAN 2007
Transplant Infectious Disease
Volume 9, Issue 2, pages 108–113, June 2007
How to Cite
Symeonidis, N., Jakubowski, A., Pierre-Louis, S., Jaffe, D., Pamer, E., Sepkowitz, K., O'Reilly, R.J. and Papanicolaou, G.A. (2007), Invasive adenoviral infections in T-cell-depleted allogeneic hematopoietic stem cell transplantation: high mortality in the era of cidofovir. Transplant Infectious Disease, 9: 108–113. doi: 10.1111/j.1399-3062.2006.00184.x
- Issue published online: 30 JAN 2007
- Article first published online: 30 JAN 2007
- Received 23 March 2006, revised 18 May 2006, accepted for publication 25 May 2006
- T cell depleted;
- allogeneic HSCT
Abstract: Background. Adenovirus (ADV) infection occurs in 5–21% of allogeneic hematopoietic stem cell transplants (HSCT). Symptomatic enteritis and hemorrhagic cystitis may be encountered but are seldom fatal. In contrast, mortality rates of up to 75% are reported for adenoviral pneumonia or hepatitis. Cidofovir is currently being increasingly used for treatment of adenoviral infections after HSCT. The efficacy of cidofovir in patients with invasive adenoviral infection is not established.
Findings. We reviewed 687 adult and pediatric patients who received allogeneic HSCT at our institution from 1998 through June 2005. ADV was isolated from 64 (9.3%) patients. Eleven patients received cidofovir for invasive disease occurring at median 39 days (range 3–145) post HSCT. The median age was 40 (range 6–61) years. Seventy-three percent received a T-cell-depleted graft and 18% had grade 3–4 graft-versus-host disease (GVHD) of the gut. Three out of 3 (100%) patients with adenoviral pneumonia died. One patient with hepatitis, cholecysitis, and viremia cleared the infection after 3 months. Two out of 7 (28.6%) patients with hemorrhagic colitis or cystitis died of ADV (1 with extensive GVHD).
Conclusion. Mortality rates of ADV pneumonitis after allogeneic HSCT remain high in the era of cidofovir. Clinical trials are needed to evaluate management strategies for this life-threatening infection.