Published in:
01-08-2012 | Original Article
Incidence and treatment strategy for disseminated adenovirus disease after haploidentical stem cell transplantation
Authors:
Kyoko Taniguchi, Satoshi Yoshihara, Hiroya Tamaki, Tsuguto Fujimoto, Kazuhiro Ikegame, Katsuji Kaida, Jun Nakata, Takayuki Inoue, Ruri Kato, Tatsuya Fujioka, Masaya Okada, Toshihiro Soma, Hiroyasu Ogawa
Published in:
Annals of Hematology
|
Issue 8/2012
Login to get access
Abstract
Adenovirus (AdV) infection is an emerging complication in patients undergoing allogeneic stem cell transplantation (SCT) and is closely associated with delayed immune reconstitution. In particular, disseminated AdV disease accompanies a high mortality. We retrospectively examined the incidence of AdV infection in patients undergoing unmanipulated haploidentical SCT. Following 121 transplantations in 110 patients, three had asymptomatic AdV viremia, three had localized AdV disease (hemorrhagic cystitis, HC), and seven had disseminated AdV disease (HC + viremia). The median time from transplantation to the onset of AdV-associated HC was 15 days (range 4–39), and the median time to the onset of disseminated AdV disease was 23 days (range 7–38). The cumulative incidence of AdV-associated HC was 8.3 %, and that of disseminated AdV disease was 5.8 %. AdV group B (type 11, type 34, or type 35) was detected in plasma samples from all the patients with disseminated AdV disease. Among them, three patients who received either cidofovir or donor lymphocyte infusion (DLI) alone progressed to pneumonia and died. The remaining four patients were treated with the combination of cidofovir and low-dose unmanipulated DLI, and all survived. We showed that disseminated AdV disease is a significant complication after haplo-SCT and that the combination of cidofovir and DLI is a promising treatment option.