Biology of Blood and Marrow Transplantation 9:341-352 (2003) 䊚 2003 American Society for Blood and Marrow Transplantation 1083-8791/03/0905-0007$30.00/0 doi:10.1016/S1083-8791(03)00102-2
Adenovirus Infection in Hematopoietic Stem Cell Transplantation: Effect of Ganciclovir and Impact on Survival Benedetto Bruno,1,5 Theodore Gooley,1 Robert C. Hackman,1,3,4 Chris Davis,1 Lawrence Corey,1,2,4 Michael Boeckh1,2 1
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle; the 2Department of Medicine, Department of Pathology and 4Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington USA; 5Divisione Universitaria di Ematologia, Azienda Ospedaliera San Giovanni Battista, Torino, Italy.
3
Correspondence and reprint requests: Michael Boeckh, MD, Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D3-100, PO Box 19024, Seattle, WA 98109-1024 (e-mail:
[email protected]). Received November 8, 2002; accepted March 20, 2003
ABSTRACT Adenoviruses (ADV) are emerging as important causes of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). In mainly non-T– cell depleted HSCT recipients, we analyzed the incidence of ADV infection, risk factors for infection, the effect of ganciclovir administered for prevention of cytomegalovirus (CMV), and the impact of ADV infection on survival. The overall incidence of ADV, irrespective of the method of detection, was 8.5% (450/5233) and 12.3% (43/348) after the first or second allogeneic HSCT, and 6.3% (78/1219) and 6.5% (5/77) after the first or second autologous HSCT, respectively. The most frequent sites of infection and disease were stool and gastrointestinal tract, respectively. Statistically significant risk factors associated with ADV infections among allogeneic recipients included younger age, grade II to IV graft-versus-host disease, year of transplantation, and a second allogeneic HSCT. Furthermore, allogeneic patients seronegative for CMV at transplantation and seropositive allogeneic patients who did not receive ganciclovir, either at engraftment or as pre-emptive therapy on CMV reactivation, were at higher risk of developing ADV infections compared with seropositive patients who received ganciclovir (odds ratioⴝ1.8, 95% confidence interval (CI) 1.2 to 2.8, Pⴝ.005 and odds ratioⴝ3.4, 95% CI 2.1 to 5.55, P12 cGy TBI 101
After Second Transplant (%)
450 (8.5) 28 (range,0.5–61)
43 (12) 18 (range,2–61)
177 (39) 76 (17) 93 (21) 73 (16) 31 (7) —
22 (51) 9 (20) 6 (14) 4 (9) 1 (2) 1
224 (49) 106 (24) 120 (27)
27 (63) 10 (23) 6 (14)
426 (95) 9 (2) 1 (
