title: Incidence and treatment strategy for disseminated adenovirus disease after haploidentical stem cell transplantation.
abstract: Adenovirus (AdV) infection is an emerging complication in patients undergoing allogeneic stem cell transplantation (SCT) and is closely associated with delayed immune reconstitution. In particular, disseminated AdV disease accompanies a high mortality. We retrospectively examined the incidence of AdV infection in patients undergoing unmanipulated haploidentical SCT. Following 121 transplantations in 110 patients, three had asymptomatic AdV viremia, three had localized AdV disease (hemorrhagic cystitis, HC), and seven had disseminated AdV disease (HC + viremia). The median time from transplantation to the onset of AdV-associated HC was 15 days (range 4-39), and the median time to the onset of disseminated AdV disease was 23 days (range 7-38). The cumulative incidence of AdV-associated HC was 8.3 %, and that of disseminated AdV disease was 5.8 %. AdV group B (type 11, type 34, or type 35) was detected in plasma samples from all the patients with disseminated AdV disease. Among them, three patients who received either cidofovir or donor lymphocyte infusion (DLI) alone progressed to pneumonia and died. The remaining four patients were treated with the combination of cidofovir and low-dose unmanipulated DLI, and all survived. We showed that disseminated AdV disease is a significant complication after haplo-SCT and that the combination of cidofovir and DLI is a promising treatment option.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yoshihara
authors.forename: Hiroya
authors.initials: H
authors.lastname: Tamaki
authors.forename: Tsuguto
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikegame
authors.forename: Katsuji
authors.initials: K
authors.lastname: Kaida
authors.forename: Jun
authors.initials: J
authors.lastname: Nakata
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inoue
authors.forename: Ruri
authors.initials: R
authors.lastname: Kato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fujioka
authors.forename: Masaya
authors.initials: M
authors.lastname: Okada
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Soma
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006648:Histocompatibility / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000009:adverse effects; D019562:Viral Load; D055815:Young Adult