Viral kinetics and outcomes of adenovirus viremia following allogeneic hematopoietic cell transplantation.

Autor: Chandorkar A; Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA., Anderson AD; Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA., Morris MI; Immunocompromised Host Service, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA., Natori Y; Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA.; Division of Infectious Diseases, Miami Transplant Institute, Jackson Health System, Miami, Florida, USA., Jimenez A; Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA., Komanduri KV; Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA., Camargo JF; Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2021 Dec; Vol. 35 (12), pp. e14481. Date of Electronic Publication: 2021 Sep 28.
DOI: 10.1111/ctr.14481
Abstrakt: Background: Adenovirus (AdV) is a serious infection following hematopoietic cell transplantation (HCT). Little is known about AdV viral kinetics and optimal threshold for initiation of pre-emptive therapy.
Methods: Single-center retrospective study of 16 consecutive adult HCT recipients with detectable AdV identified over a 5-year period.
Results: Median time to AdV reactivation after HCT was 176 days (IQR 86-408). Nine patients received cidofovir, although 14/16 had no tissue-invasive disease. Among treated patients, median duration of viremia was shorter when initiating treatment at viral loads < 10,000 copies/ml (28 vs. 52 days). All-cause mortality in this cohort was 44%. All six patients (five of which were untreated) with peak viral loads < 10,000 copies/ml survived; whereas only 30% (3/10) of patients with peak viral loads greater than this threshold survived, despite most (n = 8; 80%) of them receiving cidofovir (P = .01). Three-month survival following diagnosis of AdV viremia was significantly lower with peak viremia > 10,000 copies/ml (100 vs. 17%; P = .005).
Conclusion: AdV is associated with high all-cause mortality, especially for viremia > 10,000 copies/ml. Delaying therapy until viremia reaches AdV levels ≥10,000 copies/ml was associated with more protracted infection and poor outcomes. Larger studies are needed.
(© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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