Screening and Treatment of Adenovirus Infection in Pediatric and Adult Allogeneic Hematopoietic Cell Transplant Recipients: Multicenter Survey of Transplant Centers in the United States

Abstract

Introduction Allogeneic hematopoietic cell transplant (allo-HCT) recipients are at risk of life-threatening viral infections. Objective The objective of the AdVance US practice patterns survey was to characterize current practices in screening and treatment of adenovirus (AdV) infection in the United States (US). Methods Physicians at participating centers were provided with a link to access an online survey. The survey questions addressed current practices around management of AdV infections in allo-HCT recipients at their center, and classified patients with regard to known risks for AdV infection (e.g., T-cell depletion, cord blood, haploidentical, mismatched, GVHD). When necessary, respondents consulted with other physicians in their center to ensure consensus before submitting responses. Results 62 centers were approached, of which 15 (24%) agreed to participate in this survey prior to the first deadline for response. 11 of the participating centers treat pediatric patients and 4 treat adult patients (Figure). According to CIBMTR data and physician interview responses, the pediatric and adult centers conduct an average of 36 and 142 allo HCTs per year, respectively. Almost all (91%) pediatric centers conduct weekly routine screening for AdV after allo-HCT among higher-risk patients, and around half (55%) conduct routine screening for AdV among lower-risk patients. Routine AdV screening is conducted by 25% of adult centers for higher-risk patients, and none routinely screen lower-risk patients. Among those screening higher-risk patients for AdV, all pediatric and adult centers screen blood samples at least once weekly and the majority (90%) of pediatric centers screen blood for at least 3 months post allo-HCT; the one adult center that screens blood does so weekly for up to 6 months post-HCT. Most pediatric centers have a pre-emptive AdV treatment approach for higher-risk patients (91%) and lower-risk patients (82%), using positive blood PCR as the treatment trigger. All adult centers that screen higher-risk patients use a pre-emptive approach. The pre-emptive AdV treatment most frequently reported by pediatric and adult centers is off-label IV cidofovir in spite of well-known toxicity concerns including renal injury. Conclusions The AdVance US practice patterns survey suggests that pediatric centers are more likely than adult centers to screen for AdV, and are also more likely to have a pre-emptive AdV treatment approach compared to adult centers. Perceived risk of AdV infection is a determining factor for whether routine screening and pre-emptive treatment are implemented. For both pediatric and adult centers, AdV viremia was the most common pre-emptive treatment trigger, with off-label IV cidofovir commonly utilized for treatment in spite of toxicity concerns. Treatment practices in the centers surveyed are generally consistent with ASBMT guidelines.