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Adenovirus detected in few allogeneic HSCT patients
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Mortality related to adenoviremia was low among patients receiving alemtuzumab-based allogeneic hematopoietic stem cell transplants, researchers from University College London Hospital have found.
“Our study suggests that, somewhat contrary to established belief, adenoviral infections are not as big a problem following T-cell–depleted transplants,” Karl Peggs, MD, senior lecturer in stem cell transplantation and immunotherapy at the University College London, told Infectious Disease News. “Associated mortality was less than 1% for the entire cohort in our experience. This may reflect modern surveillance strategies.”
Karl Peggs
To determine the clinical effect of adenoviremia in these patients, the Peggs and colleagues conducted weekly blood testing using quantitative polymerase chain reaction on all patients who received alemtuzumab (Campath, Ilex Pharmaceuticals)-based allogeneic hematopoietic stem cell transplants (HSCTs) at the University College London Hospital from January 2008 to January 2011. The study included 116 patients.
Fourteen patients (12.1%) developed adenoviremia with a titer >200 copies/mL. The median time to first detectable titer was 28 days after transplant. The median time to the maximum titer was 49 days after transplant. A lymphoid diagnosis and a positive cytomegalovirus serostatus were significantly correlated with adenovirus. Five patients whose peak titers were between 99,000 copies/mL and 2.5 million copies/mL received cidofovir. The survival was comparable among all patients, regardless of titers.
“These data suggest that the introduction of routine surveillance for adenoviremia may be helpful and that the detection of low viral loads may not require any intervention,” Peggs said. “In addition, the data also show that the combination of cidofovir and a reduction in immune suppression is successful in most cases with higher viral loads.”
In an accompanying editorial, Gabriela Soriano, MD, and Miguel-Angel Perales, MD, both of the Adult Bone Marrow Transplantation Service of Memorial Sloan-Kettering Cancer Center, wrote that this study does not establish optimal screening methods for adenovirus, but it does have potential to detect infections early.
“Further studies will need to examine this screening approach in other transplant regimens that do not incorporate alemtuzumab,” they wrote. “With the advent of novel agents to treat adenovirus and a growing number of targeted cellular therapies, early identification will become all the more relevant.”
For more information:
Sive J. Clin Infect Dis. 2012;55:1362-1370.
Soriano G. Clin Infect Dis. 2012;55:1371-1372.
Disclosure: The researchers report no relevant financial disclosures.