Treatment of adenovirus infections in patients undergoing allogeneic hematopoietic stem cell transplantation.
Retrospective analysis of 303 patients who underwent allogeneic hematopoietic stem cell transplantation identified 35 (11.5%) with adenovirus infection. Among them, 22 received specific therapy. As first-line therapy, 18 were treated with intravenous ribavirin, 3 with cidofovir, and 1 with vidarabine. Moreover, 2 received donor leukocyte infusion in combination with ribavirin, and 1 received it after failing to respond to other therapies. Seven survived (31.8%; 3 of 13 who received ribavirin alone and 2 of 3 who received cidofovir). Among the 5 patients treated with combined strategies, 2 who received donor leukocyte infusions showed clearance of all symptoms. Acute graft-versus-host disease grade > or = 3 (P = .01) and a long delay between infection and treatment (P = .05) correlated with a greater risk of treatment failure. In conclusion, ribavirin and vidarabine are ineffective options, particularly for patients at who are high risk of acquiring disseminated adenovirus disease. Conversely, cidofovir or donor leukocyte infusions seem to be encouraging approaches if initiated early.
Bordigoni
P
P
Bone Marrow Transplantation Unit, Children's Hospital, Centre Hospitalier Universitaire, Nancy, France. p.bordigoni@chu-nancy.fr
Carret
A S
AS
Venard
V
V
Witz
F
F
Le Faou
A
A
D000258:Adenovirus Infections, Human / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D000260:Adenoviruses, Human / Q000145:classification / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000627:therapeutic use
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D012254:Ribavirin; D003596:Cytosine; D014740:Vidarabine; D000077404:Cidofovir