Adenovirus viremia and disease: Comparison between T-cell depleted (TCD) and Conventional (CONV) hematopoietic stem cell transplant recipients (HSCT) from a single institution

Background—ADV (adenovirus) is an important cause of viral mortality in hematopoietic stem cell transplantation (HSCT). T-cell depleted (TCD) HSCT are at increased risk of viral infections. We compared the rates and outcomes of ADV viremia and disease between TCD and conventional (CONV) HSCT at our institution. Methods—This was an observational study of 624 adult and pediatric recipients of myeloablative HSCT at Memorial Sloan-Kettering Cancer Center from January 1, 2006, through March 11, 2011. Viral cultures and ADV polymerase chain reaction (PCR) were ordered as clinically indicated. ADV viremia by a quantitative PCR assay was defined as ≥1 positive value ≥1,000 copies/mL or ≥2 consecutive values at any value. Competing risk regression analyses were used to identify predictors for ADV viremia. Results—Eight percent TCD and 4.0% CONV were noted to have ADV viremia at 1 year after HSCT (P=.041). Among TCD, 15% of children compared with 5% of adults developed ADV viremia (P=.008). Young age (Hazard Ratio [HR] 3.0; P<.001) and acute graft-versus-host-disease © 2012 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved. Corresponding Author: Genovefa A. Papanicolaou, M.D., Department of Medicine, Infectious Diseases, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 9, New York, NY 10021, Phone: 212-639-8361, Fax: 646-422-2124, papanicg@mskcc.org. *Authors equally contributed to the work +Co-senior authors Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Biol Blood Marrow Transplant. Author manuscript; available in PMC 2014 June 09. Published in final edited form as: Biol Blood Marrow Transplant. 2013 March ; 19(3): 387–392. doi:10.1016/j.bbmt. 2012.10. 014. N IH -P A A uhor M anscript N IH -P A A uhor M anscript N IH -P A A uhor M anscript (GVHD) (HR 3.2; P=.001) were risk factors for ADV viremia. ADV viremia was a predictor of mortality (HR 6.0; P<.001). ADV disease developed in 3.5% TCD and 0.4% CONV HSCT (P=. 022) with attributable mortality of 27%. Among TCD, grade 2–4 GVHD was a risk factor for ADV disease (HR 13; P<.001); age was not significant. More than 90% ADV disease cases had a viral load of ≥ 10,000 copies/mL. Conclusions—Rates of ADV disease were 10-fold higher in TCD compared with CONV HSCT, predominantly in patients who developed acute GVHD. The benefit of preemptive therapy for ADV viral load ≥ 10,000 copies/mL for prevention of ADV disease in recipients of TCD grafts should be evaluated in prospective clinical trials.