Mortality of disseminated adenovirus (ADV) infection after allogeneic HSCT in the era of cidofovir Meeting Abstract

  


Authors: Almyroudis, N.; Symeonidis, N.; Sepkowitz, K. A.; Pamer, E. G.; Papadopoulos, E.; Small, T. N.; Papanicolaou, G. A.
Abstract Title: Mortality of disseminated adenovirus (ADV) infection after allogeneic HSCT in the era of cidofovir
Meeting Title: 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy
Abstract: Background: ADV is a significant pathogen in HSCT patients (pts). Symptomatic GI (enteritis) and GU (hemorrhagic cystitis) infection is usually self limited. In contrast, ADV pneumonia has a mortality of 75%, demonstrating the need for effective antiviral therapy. We examined the efficacy and toxicity of cidofovir (CDV) in 9 pts with severe ADV infection. Methods: Prospective cohort of HSCT recipients at MSKCC, from 1998-2002. Culture-pos sites: lung (R), GI/GU or both GI/R. CDV given as 5mg/kg weekly (7pts) or 1mg/kg qod (2 pts) along with IVIg. Toxicity: creatinine increase >2X baseline. Results: Out of 437 pts, 41 (9.3%) had ADV infection. Compared to the cohort ADV cases were younger, had unrelated HSCT and GVHD (p<0.05). ADV incidence and date of onset are given. Outcome of untreated ADV: 22 pts with GI (4 w/ GU) cleared ADV. 4/5 (80%) pts with GI/R during 0-180 days expired with disseminated (d) ADV. 0/4 pts with late (>180 days) R or GI/R ADV expired due to ADV. Outcome of 9 pts treated w/ CDV: day 0-90: 3/4 (75%) with GI/R expired with d-ADV. 1/2 pts with GI ADV cleared the infection, 1 died from bacterial sepsis. Day >90: 3/3 pts with GI (2 w/ GU) ADV were treated successfully w/ CDV. 8 treated pts were evaluated for nephrotoxicity:. 3/4 (75%) w/ GI/R and 2/2 w/ GI ADV w/ coinfection developed nephrotoxicity, 1 required dialysis. There was no CDV toxicity in 2 pts with isolated GI ADV. Conclusions: 1) d-ADV occurred in 25% of early cases. 2) Mortality of d-ADV that occurred before day 180 was similar in treated and untreated pts (75% Vs 83%). 3) Nephrotoxicity occurred in 83% of GI/R pts treated w/ CDV. 4) Improved treatment modalities are needed for early d-ADV post HSCT.
Journal Title: Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy
Volume: 43
Meeting Dates: 2003 Sep 14-17
Meeting Location: Chicago, IL
ISSN: 0733-6373
Publisher: American Society for Microbiology  
Date Published: 2003-09-01
Start Page: 380
Language: English
ACCESSION: BCI:BCI200400025954
PROVIDER: biosis
Notes: Meeting Anstract: K-1375 -- 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy -- Chicago, IL, USA -- September 14-17, 2003 -- American Society for Microbiology -- Source: Biosis