Adenovirus Infection in Allogeneic Stem Cell Transplantation

Chapter

Abstract

Adenoviruses (HAdVs) are nonenveloped lytic DNA viruses with 67 different human serotypes. HAdV infection post transplant seems to be caused by endogenous viral reactivation in most cases. Quantitative HAdV PCR-diagnostics in peripheral blood (PB) samples has become gold standard. The incidence of HAdV viremia varies between 5 % and 68 %. The main risk factor for HAdV infection is prolonged immunosuppression, attributable either to in vivo or ex vivo T-cell depletion, prolonged lymphopenia, or to GvHD-associated immunosuppressive posttransplant therapy. For patients at risk, weekly PCR screening is recommended. The first symptoms of HAdV disease are frequently diarrhea, fever, elevated liver enzymes, and secondary pancytopenia. High levels of HAdV DNA in PB predicts disseminated HAdV disease, which is lethal despite virostatic treatment in most cases. Standard treatment for HAdV infections is cidofovir. The compound brincidofovir, an orally bioavailable lipid conjugate of cidofovir is currently being tested in several prospective trials. However, the recovery of HAdV-specific immunity seems to be critical for successful antiviral therapy. The transfer of HAdV-specific donor T cells in patients with HAdV viremia has been evaluated in several clinical phase I/II trials and preliminary data suggest that this approach may be feasible and effective.

Keywords

Adenovirus Allogeneic stem cell transplantation Risk factors Cidofovir Brincidofovir Adoptive virus-specific T-cells 

Notes

Acknowledgments.

We thank Thomas Lion who contributed to the diagnostic section. We would also like to thank Andreas Heitger, Rene Geyeregger, and Stephan Ladisch for carefully reading and editing the manuscript and Helmut Gadner for his continuous support—without him this work would not have been possible.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Stem Cell TransplantationSt. Anna Children’s Hospital, Medical UniversityViennaAustria

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