Adenovirus Viremia and Disease: Comparison of T Cell-Depleted and Conventional Hematopoietic Stem Cell Transplantation Recipients from a Single Institution Journal Article


Authors: Lee, Y. J.; Chung, D.; Xiao, K.; Papadopoulos, E. B.; Barker, J. N.; Small, T. N.; Giralt, S. A.; Zheng, J.; Jakubowski, A. A.; Papanicolaou, G. A.
Article Title: Adenovirus Viremia and Disease: Comparison of T Cell-Depleted and Conventional Hematopoietic Stem Cell Transplantation Recipients from a Single Institution
Abstract: Adenovirus (ADV) is an important cause of viral mortality in hematopoietic stem cell transplantation (HSCT). Recipients of T cell-depleted (TCD) HSCT are at increased risk for viral infections. We compared the rates and outcomes of ADV viremia and disease between TCD and conventional (CONV) HSCT at our institution. This was an observational study of 624 adult and pediatric recipients of myeloablative HSCT at Memorial Sloan-Kettering Cancer Center between January 1, 2006, and March 11, 2011. Viral cultures and ADV PCR were ordered as clinically indicated. ADV viremia by quantitative PCR assay was defined as 1 or more positive values ≥1,000 copies/mL or 2 or more consecutive positive values. Competing-risk regression analyses were used to identify predictors for ADV viremia. ADV viremia at 1 year after HSCT occurred in 8% of TCD HSCT recipients and in 4.0% of CONV HSCT recipients (P = .041). Among the TCD recipients, ADV viremia was seen in 15% of children, compared with 5% of adults (P = .008). Young age (hazard ratio [HR], 3.0; P < .001) and acute graft-versus-host disease (GVHD) (HR, 3.2; P = .001) were identified as risk factors for ADV viremia. ADV viremia was predictive of mortality (HR, 6.0; P < .001). ADV disease developed in 3.5% of TCD HSCT recipients and in 0.4% of CONV HSCT recipients (P = .022), with an attributable mortality of 27%. Among TCD HSCY recipients, grade II to IV GVHD was a risk factor for ADV disease (HR, 13; P < .001), but age was not. More than 90% of the cases of ADV disease involved a viral load of ≥10,000 copies/mL. Rates of ADV disease were 10-fold greater in TCD HSCT recipients compared with CONV HSCT recipients, predominantly in patients who developed acute GVHD. The benefit of preemptive therapy for an ADV viral load ≥10,000 copies/mL for preventing ADV disease in TCD HSCT recipients should be evaluated in prospective clinical trials. © 2013 American Society for Blood and Marrow Transplantation.
Keywords: mortality; polymerase chain reaction; infection; risk factor; bone marrow transplantation; virus
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 19
Issue: 3
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2013-03-01
Start Page: 387
End Page: 392
Language: English
DOI: 10.1016/j.bbmt.2012.10.014
PROVIDER: scopus
PUBMED: 23092814
PMCID: PMC4049479
DOI/URL:
Notes: --- - "Export Date: 1 March 2013" - "CODEN: BBMTF" - "Source: Scopus"
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MSK Authors
  1. Junting Zheng
    155 Zheng
  2. Trudy Small
    215 Small
  3. Yeon Joo Lee
    31 Lee
  4. Sergio Andres Giralt
    620 Giralt
  5. Juliet N Barker
    253 Barker
  6. Dick Chung
    13 Chung
  7. Kun Xiao
    9 Xiao