Adenovirus infection in adult patients undergoing allogeneic hematopoietic stem cell transplant: Incidence, clinical management, and outcome

Abstract

BackgroundAdenovirus 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.MethodsIn 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.ResultsIn 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).ConclusionsIn 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. image