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Incidence and treatment strategy for disseminated adenovirus disease after haploidentical stem cell transplantation

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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.

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Acknowledgments

We thank the medical, nursing, and laboratory staff of the participating departments for their contributions to this study. We are also grateful to Ms. Aya Yano and Ms. Kimiko Yamamoto for their technical assistance and to Mr. Shigeo Kimura, Ms. Kazuko Saida, and Ms. Kumiko Sugawara for their assistance with data collection.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Kyoko Taniguchi, Satoshi Yoshihara, Kazuhiro Ikegame, Katsuji Kaida, Jun Nakata, Takayuki Inoue, Ruri Kato, Tatsuya Fujioka, Masaya Okada, Toshihiro Soma & Hiroyasu Ogawa

  2. Laboratory of Cell Transplantation, Institute for Advanced Medical Sciences, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Hiroya Tamaki & Hiroyasu Ogawa

  3. Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan

    Tsuguto Fujimoto

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  1. Kyoko Taniguchi
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  2. Satoshi Yoshihara
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  3. Hiroya Tamaki
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  4. Tsuguto Fujimoto
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Correspondence to Satoshi Yoshihara.

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Taniguchi, K., Yoshihara, S., Tamaki, H. et al. Incidence and treatment strategy for disseminated adenovirus disease after haploidentical stem cell transplantation. Ann Hematol 91, 1305–1312 (2012). https://doi.org/10.1007/s00277-012-1440-3

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  • DOI: https://doi.org/10.1007/s00277-012-1440-3

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