Yazarlar : Watson T, Macdonald D, Song X, Bromwich K, Campos J, Sande J, Debiasi RL.

Yayın : Biol Blood Marrow Transplant.

Yayın Yılı : 2012

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22281300

Konu : Kemik İliği Nakli

Literatür İçeriği :  

Abstract

Adenovirus (AdV) infections are a major cause of morbidity and mortality in hematopoietic stem cell transplant HSCT) patients. To evaluate the use of molecular AdV testing in HSCT at our institution and identify risk factors for AdV viremia and disease, we performed a retrospective cohort study of allHSCT patients who had undergone AdV polymerase chain reaction (PCR) testing, over a two year period. Two cohorts were identified: Cohort 1 consisted of patients testing positive for AdV (n=7); Cohort 2 consisted of patients testing negative (n=36). Overall patient characteristics were not statistically different between cohorts. The following medication exposures were identified as risk factors influencing AdV status by comparing Cohort 1 with Cohort 2: preparatory regimens utilizing fludarabine (RR 8.73, CI 1.18-64.27, p 0.006), melphalan (RR 3.47, CI 0.76-15.94, p 0.08), and/or cyclophosphamide (RR 0.18, CI 0.02-1.4, p 0.05), and GVHD prophylaxis with methylprednisone (RR 3.73, CI 1.01-13.9, p 0.04). AdV+ pts had higher GVHD grades with higher rates of GVHD of the gastrointestinal tract (RR 4, CI 1.18-13.5, p 0.03) compared to AdV- pts. Amongst pts with AdV+ testing, 4/7 had concomitant clinical manifestations of disease including: pneumonia, diarrhea, and/or disseminated disease. Clinical outcomes in symptomatic pts included resolution of disease in 2/4 pts, and death in 2/4 pts. All AdV+ pts received antiviral therapy, including one pt with severe disseminated disease that resolved following administration of liposomal cidofovir. Our study at a large pediatric HSCT center provides important preliminary data for development of a prospective trial destined to identify specific HCST patient subpopulations that might benefit most from molecular screening and early pre-emptive therapy.

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