How I treat adenovirus in hematopoietic stem cell transplant recipients

Lindemans, Caroline A.; Leen, Ann M.; Boelens, Jaap Jan

doi:10.1182/blood-2010-04-259291

Cited by 212 publications

(220 citation statements)

References 81 publications

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“…In contrast, nucleotide analogues like cidofovir requires two-staged phosphorylation with the help of monophosphate kinase and pyruvate kinase to form active metabolite which selectively inhibits viral DNA polymerase. Presently cidofovir is FDA approved for CMV retinitis in HIV patients only, however many reports of this broad spectrum antiviral drug have shown its efficacy in adenovirus and related infections [13,14]. Lindemans et al proposed algorithm to treat adenovirus infection and disease based on risk categorization, viral load, and failure to respond to pre-emptive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Lindemans et al proposed algorithm to treat adenovirus infection and disease based on risk categorization, viral load, and failure to respond to pre-emptive treatment. The recommended dose of cidofovir is 1 mg/kg/day (along with probenecid and hyper hydration) thrice a week [13]. In severe cases, intra-vesical instillation of cidofovir has been used successfully.…”

Section: Discussionmentioning

confidence: 99%

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

Sahu

Prakash

Khadwal

et al. 2015

Indian J Hematol Blood Transfus

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Post bone marrow transplant patients are susceptible to atypical infections, especially viral pathogens. The risk increases many folds in cases of allogeneic transplantation, which also receive GVHD prophylaxis. Viral pathogens like cytomegalovirus and herpes are the common ones encountered during follow-up period. However, in recent times there have been reports of a variety of disease manifestations of rare viruses like polyoma virus and adenovirus. These viral infections may play a crucial role in morbidity and mortality in immunocompromised patients. We hereby elaborate the follow-up course of a 36-year-old post allogeneic transplant patient of acute myeloid leukemia who developed adenovirus related haemorrhagic cystitis. Treatment with oral ribavirin lead to dramatic improvement in symptomatology within a week. This cases re-emphasizes the fact that after ruling out the commoner pathogens, it's of utmost importance to strongly consider the atypical pathogens in such cases. Case-ReportA 36-year-old gentleman, known case of acute myeloid leukemia (FAB-M2) was admitted on Day ?380 of allogeneic stem cell transplant with 7 days history of lower urinary tract symptoms (LUTS), dysuria, increased urine frequency, urgency of urine, and haematuria. In the background, patient received inj. busulphan (0.8 mg/kg every 6 h for 4 days) and inj. cyclophosphamide (60 mg/kg/day for 2 days) as conditioning regimen. Peri-transplant period was unremarkable for any complication. No features of high dose cyclophosphamide induced cystitis or acute graft versus host disease (aGVHD) was noted. He received cyclosporine-A (5 mg/m 2 ) and methotrexate 15 mg/m 2 on Day ?1 and 10 mg/m 2 on Day ?3, ?6 and ?11 as prophylaxis for GVHD (Fig. 1). Tapering of immunosuppression was started on Day ?80 onwards and patient did not have any evidence of GVHD till Day ?256. Following which he developed lichenoid changes in the oral mucosa, dryness of eyes and hypopigmented patches over the face and upper trunk involving \25 % of body surface (Fig. 2). Liver function tests showed total bilirubin levels-1.2 g/dL, SGOT, SGPT and SALP of 92, 139, 392 IU/mL, respectively. After clinical examination, laboratory evaluation and liver?skin biopsy he was diagnosed as moderate cGVHD (Table 1). As a result additional immunosuppressive medications in the form of mycophenolate (1000 mg BD) along with oral prednisolone was started. He also received topical cyclosporine eye drops (0.05 %) for conjunctival GVHD. Following immunosuppressive therapy symptoms related to GVHD started improving (Fig.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Sahu

Prakash

Khadwal

et al. 2015

Indian J Hematol Blood Transfus

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“…Moreover, all patients with a fatal outcome had peak loads >10 7 copies/ml. Other authors noted that regardless of the peak HAdV loads, rapidly rising HADV loads were observed before onset of symptoms, underlining that monitoring the HAdV load kinetics might be at least as important as any proposed HAdV load threshold value [14,16].…”

Section: To Treat or Not To Treatmentioning

confidence: 99%

“…As cidofovir had a broader range of activity against different HAdV types and clinical isolates, a multitude of case reports and noncontrolled studies on its use have been published. Although both recovery and treatment failures have been reported for both cidofovir [1][2][3]16,17] and ribavirin [3,4], more clinical experience has been gained with cidofovir. CMX001, a prodrug of cidofovir, has a higher in vitro activity against HAdV and is less nephrotoxic than cidofovir.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…A randomized, placebo-controlled multisite Phase II study (the Adv Halt trial) on the safety and efficacy of preemptive treatment with CMX001 for the prevention of adenovirus disease following hematopoietic SCT in adults and children is ongoing. Moreover, adoptive transfer of HAdV-specific donor T cells has been recommended to control HAdV replication but no controlled studies have been published [16].…”

Section: Treatment Optionsmentioning

confidence: 99%

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Advances in the management of disseminated adenovirus disease in stem cell transplant recipients: impact of adenovirus load (DNAemia) testing

Heim

2011

Expert Review of Anti-infective Therapy

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Adenovirus persistence, reactivation, and clinical management

2019

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Adenoviral infections continue posing a major threat in severely immunocompromised patients including particularly allogeneic stem cell transplant recipients. Although exogenous infections occur in some instances, the majority of invasive events appear to arise from viral reactivation. In the pediatric setting, adenoviruses were demonstrated to persist in the gastrointestinal tract, and the intestinal epithelium serves as the main site of viral replication preceding invasive infection. Regular monitoring of serial stool samples for the presence and load of adenoviruses has therefore become a routine diagnostic tool for post‐transplant patient surveillance, and can serve as a trigger for early initiation of treatment. In the adult setting, the source of infection or reactivation is less clear, and monitoring of peripheral blood specimens is the predominant approach for patient surveillance. Timely initiation of antiviral treatment is reportedly required for prevention or successful control of disseminated disease mediated by adenoviruses, and appropriate diagnostic monitoring is therefore of paramount importance. Currently available antiviral agents and immune therapeutic approaches have not been able to entirely overcome the life‐threatening courses of invasive adenoviral infections in the immunocompromised clinical setting.

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How I treat adenovirus in hematopoietic stem cell transplant recipients

Cited by 212 publications

References 81 publications

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

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

Advances in the management of disseminated adenovirus disease in stem cell transplant recipients: impact of adenovirus load (DNAemia) testing

Adenovirus persistence, reactivation, and clinical management

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