Runde V, Ross S, Trenschel R, Lagemann E, Basu O, Renzing-Köhler K, Schaefer U W, Roggendorf M, Holler E
Department of Bone Marrow Transplantation, University Hospital Essen, Germany.
Bone Marrow Transplant. 2001 Jul;28(1):51-7. doi: 10.1038/sj.bmt.1703083.
The incidence of adenovirus (AV) infections following SCT was determined in a prospective multicenter trial. Over 1 year, 130 consecutive patients undergoing allogeneic SCT at Essen University Hospital were included and followed for 6 months. Source of stem cells was blood in 68 cases. Fifty-eight patients had HLA-identical sibling donors. Throat swabs, urine and stool samples were screened weekly for AV antigen and DNA by ELISA and nested PCR, respectively. In 35 cases adenovirus infection was detected. There was no seasonal variation. Throat swabs were positive in 24, urine in 12, and stool in 11 cases, resulting in a cumulative risk of infection of 29%. The incidences of AV infection of the respiratory, gastrointestinal and urinary tract were 19%, 10%, and 9%, respectively, and infections were diagnosed after a median (range) interval of 44 (-2-179), 37 (-2-168), and 53 (17-153) days after transplantation. On multivariate analysis, presence of AV antibody in the donor and acute graft-versus-host disease grade IV were found to be independent risk factors for AV infection. Eleven patients had AV isolated from more than one site and five patients had probable AV disease. We were not able to identify patients in whom AV infection was the leading cause of death. The majority of patients infected with AV suffered from severe acute graft-versus-host disease often accompanied by other opportunistic infections, such as aspergillosis or CMV reactivation. Nineteen out of 36 patients who died during the observation period had AV infection. In summary, AV infection after allogeneic SCT was observed in a substantial number of patients. In addition to well-known risk factors for viral infection after SCT we were able to demonstrate that a positive AV antibody test in the donor is an important risk factor for AV infection. Further studies are needed, however, before final conclusions on the clinical sequelae of AV infection can be made and the role of preventive and therapeutic strategies toward AV infection after allogeneic SCT can be defined.
在一项前瞻性多中心试验中确定了异基因造血干细胞移植（SCT）后腺病毒（AV）感染的发生率。在1年多的时间里，埃森大学医院连续130例接受异基因SCT的患者被纳入研究并随访6个月。68例患者的干细胞来源为血液。58例患者有人类白细胞抗原（HLA）相同的同胞供者。每周分别通过酶联免疫吸附测定（ELISA）和巢式聚合酶链反应（PCR）对咽拭子、尿液和粪便样本进行AV抗原和DNA筛查。35例患者检测到腺病毒感染。无季节性变化。24例咽拭子阳性，12例尿液阳性，11例粪便阳性，累积感染风险为29%。呼吸道、胃肠道和泌尿道的AV感染发生率分别为19%、10%和9%，感染分别在移植后中位（范围）44（-2 - 179）、37（-2 - 168）和53（17 - 153）天被诊断。多因素分析发现，供者存在AV抗体和急性移植物抗宿主病（GVHD）IV级是AV感染的独立危险因素。11例患者在多个部位分离出AV，5例患者可能患有AV疾病。我们未能确定AV感染是主要死因的患者。大多数感染AV的患者患有严重的急性GVHD，常伴有其他机会性感染，如曲霉病或巨细胞病毒（CMV）再激活。在观察期内死亡的36例患者中有19例发生AV感染。总之，在大量异基因SCT患者中观察到了AV感染。除了SCT后病毒感染的已知危险因素外，我们还能够证明供者AV抗体检测呈阳性是AV感染的一个重要危险因素。然而，在对AV感染的临床后果得出最终结论以及确定异基因SCT后针对AV感染的预防和治疗策略的作用之前，还需要进一步研究。
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