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Risk factors identified for adenovirus infection in HSCT patients
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SAN FRANCISCO — Researchers from France have reportedly identified the most significant risk factors for adenovirus infection in pediatric hematopoietic stem cells transplant patients, according to data presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy.
Linda Feghoul, PharmD, and colleagues from Université Paris Diderot and Hôpital Robert Debré in Paris reported that age younger than 6 years, mismatch unrelated donor and cord blood transplant appear to be the most appealing risk factors for adenovirus infection.
“These factors should be considered to initiate a molecular screening for adenovirus,” the researchers concluded in their study findings, adding that patients with adenovirus infection with cord blood transplant and/or grade-3 to -4 graft-versus-host disease (GVHD) must be considered for early anti-adenovirus intervention.
From September 2010 to December 2011, the researchers prospectively followed 65 pediatric hematopoietic stem cells transplant (HSCT) patients for 12 months; patients were tested weekly for adenovirus in blood and stool. Shedding was defined as a positive detection in stool only, systemic infection as positive detection in blood, and disease as infection with adenovirus associated symptoms.
According to the study results, cumulative incidence of shedding in stools, infection and disease at 3 months post-HSCT were 39%, 21% and 17%, respectively. Risk factors were age younger than 6 years, cord blood transplantation, mismatch unrelated donor and corticosteroids in preventing GVHD for shedding in stool (HRs=2.6, 4.0, 9.1 and 3.6, respectively).
The same factors appear to predict disseminated infection (HRs=8.3, 4.2, 11.1 and 4.3, respectively) as well as grade-3 to -4 GVHD (HR=3.0), according to the researchers.
Regarding adenovirus disease, the investigators reported that cord blood transplantation (HR=3.8) and grade-3 to -4 GVHD (HR=3.7) were the most significant predictors. Data from multivariable models indicated that mismatch unrelated donor (HR=3.4) and age younger than 6 years (HR=2.9) remained associated with shedding in stool, whereas grade-3 to -4 GVHD and cord blood transplant remained associated with infection or disease (HRs=2.9, 4.1, 3.5 and 3.7, respectively),” the investigators said.