title: Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation.
abstract: Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.
authors.affiliation: Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Kampmann
authors.forename: D
authors.initials: D
authors.lastname: Cubitt
authors.forename: T
authors.initials: T
authors.lastname: Walls
authors.forename: P
authors.initials: P
authors.lastname: Naik
authors.forename: M
authors.initials: M
authors.lastname: Depala
authors.forename: S
authors.initials: S
authors.lastname: Samarasinghe
authors.forename: D
authors.initials: D
authors.lastname: Robson
authors.forename: A
authors.initials: A
authors.lastname: Hassan
authors.forename: K
authors.initials: K
authors.lastname: Rao
authors.forename: H
authors.initials: H
authors.lastname: Gaspar
authors.forename: G
authors.initials: G
authors.lastname: Davies
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.forename: C
authors.initials: C
authors.lastname: Cale
authors.forename: K
authors.initials: K
authors.lastname: Gilmour
authors.forename: M
authors.initials: M
authors.lastname: Real
authors.forename: M
authors.initials: M
authors.lastname: Foo
authors.forename: N
authors.initials: N
authors.lastname: Bennett-Rees
authors.forename: A
authors.initials: A
authors.lastname: Hewitt
authors.forename: P
authors.initials: P
authors.lastname: Amrolia
authors.forename: Paul
authors.initials: P
authors.lastname: Veys
mesh_terms: D000256:Adenoviridae / Q000235:genetics; D000257:Adenoviridae Infections / Q000150:complications*; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D005243:Feces / Q000821:virology; D015774:Ganciclovir / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000601:surgery* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016015:Logistic Models; D009305:Nasopharynx / Q000821:virology; D009666:Nose / Q000821:virology; D016133:Polymerase Chain Reaction / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D015774:Ganciclovir