Viral kinetics and outcomes of adenovirus viremia following allogeneic hematopoietic cell transplantation.

Abstract

Adenovirus (AdV) is a serious infection following hematopoietic cell transplantation (HCT). Little is known about AdV viral kinetics and optimal threshold for initiation of pre-emptive therapy. Single-center retrospective study of 16 consecutive adult HCT recipients with detectable AdV identified over a 5-year period. Median time to AdV reactivation after HCT was 176 days (IQR 86-408). Nine patients received cidofovir, although 14/16 had no tissue-invasive disease. Among treated patients, median duration of viremia was shorter when initiating treatment at viral loads<10,000 copies/ml (28vs. 52 days). All-cause mortality in this cohort was 44%. All six patients (five of which were untreated) with peak viral loads<10,000 copies/ml survived; whereas only 30% (3/10) of patients with peak viral loads greater than this threshold survived, despite most (n=8; 80%) of them receiving cidofovir (P=.01). Three-month survival following diagnosis of AdV viremia was significantly lower with peak viremia>10,000 copies/ml (100vs. 17%; P=.005). AdV is associated with high all-cause mortality, especially for viremia>10,000 copies/ml. Delaying therapy until viremia reaches AdV levels ≥10,000 copies/ml was associated with more protracted infection and poor outcomes. Larger studies are needed.