Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation
Autor: | M. Foo, M. Real, Tony Walls, Hubert B. Gaspar, Paru Naik, Graham Davies, David Cubitt, A Hassan, N. Bennett-Rees, Paul Veys, K Gilmour, A. Hewitt, Alison Jones, C Cale, M. Depala, P Amrolia, B. Kampmann, Sujith Samarasinghe, D. Robson, K Rao |
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Rok vydání: | 2005 |
Předmět: |
Ganciclovir
medicine.medical_specialty Transplantation Conditioning Adolescent Adenoviridae Infections medicine.medical_treatment Nose Antiviral Agents Polymerase Chain Reaction Gastroenterology Adenoviridae Feces chemistry.chemical_compound Risk Factors Nasopharynx Internal medicine medicine Humans Transplantation Homologous Prospective Studies Child Prospective cohort study Hematology business.industry Infant Immunosuppression Prognosis Hematologic Diseases Transplantation Logistic Models Treatment Outcome chemistry Child Preschool DNA Viral Immunology Stem cell business Immunosuppressive Agents Stem Cell Transplantation medicine.drug Cidofovir |
Zdroj: | British Journal of Haematology. 130:595-603 |
ISSN: | 1365-2141 0007-1048 |
Popis: | 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. |
Databáze: | OpenAIRE |
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