Incidence and outcome of adenovirus disease in transplant recipients after reduced-intensity conditioning with alemtuzumab.
Adenoviruses are emerging as a major cause of infectious complications after allogeneic transplantation. We evaluated the incidence and outcome of symptomatic adenovirus infection or adenovirus disease after alemtuzumab-based reduced-intensity conditioning in 86 consecutive patients. The overall probability of adenovirus disease was 18.4% (11/86 patients). Five patients died of progressive adenovirus disease, and this was the most important infectious cause of mortality in this cohort. The probability of nonrelapse mortality was 49% in patients with adenovirus disease compared with 25.5% in those without (P=.007). The severity of lymphocytopenia and continuation of immunosuppressive therapy were the most important risk factors for progressive adenovirus disease and death. In contrast, patients who were not receiving immunosuppressive therapy or had had it reduced or withdrawn cleared the virus. We also detected a correlation between the lack of preemptive anti-cytomegalovirus (CMV) therapy for CMV reactivation and the risk of progressive adenovirus disease (P=.05). Our findings highlight the emergence of adenovirus as an important posttransplantation pathogen even after reduced-intensity conditioning and demonstrate the effect of the severity of lymphocytopenia, anti-CMV prophylaxis, and immunosuppressive therapy on the outcome of adenovirus disease.
Department of Haematology, University College Hospital, London, UK. i_avivi@rambam.health.gov.il
Irit
I
Avivi
Suparno
S
Chakrabarti
Donald W
DW
Milligan
H
H
Waldmann
Geoff
G
Hale
Husam
H
Osman
Katherine N
KN
Ward
Christopher D
CD
Fegan
Kwee
K
Yong
Anthony H
AH
Goldstone
David C
DC
Linch
Stephen
S
Mackinnon
D000257:Adenoviridae Infections / Q000150:complications / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008231:Lymphopenia / Q000150:complications; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000009:adverse effects; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000074323:Alemtuzumab