Hematopoietic Stem Cell Transplant Unit, Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic.
Department of Haemopoietic Stem Cell Bone Marrow Transplantation, The Royal Marsden Hospital, Sutton, London, United Kingdom.
Biol Blood Marrow Transplant. 2019 Apr;25(4):810-818. doi: 10.1016/j.bbmt.2018.12.753. Epub 2018 Dec 20.
Adenovirus (AdV) is an increasingly recognized threat to recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT), particularly when infection is prolonged and unresolved. AdVance is the first multinational, multicenter study to evaluate the incidence of AdV infection in both pediatric and adult allo-HCT recipients across European transplantation centers. Medical records for patients undergoing first allo-HCT between January 2013 and September 2015 at 50 participating centers were reviewed. The cumulative incidence of AdV infection (in any sample using any assay) during the 6 months after allo-HCT was 32% (95% confidence interval [CI], 30.9% to 33.4%) among pediatric allo-HCT recipients (n = 1736) and 6% (95% CI, 4.7% to 6.4%) among adult allo-HCT recipients (n = 2540). The incidence of AdV viremia ≥1000copies/mL (a common threshold for initiation of preemptive treatment) was 14% (95% CI, 13.0% to 14.8%) in pediatric recipients and 1.5% (95% CI, 1.1% to 2.0%) in adult recipients. Baseline risk factors for developing AdV viremia ≥1000copies/mL included younger age, use of T cell depletion, and donor type other than matched related. Baseline demographic factors were broadly comparable across patients of all ages and identified by multivariate analyses. Notably, the incidence of AdV infection decreased stepwise with increasing age; younger adults (age 18 to 34 years) had a similar incidence as older pediatric patients (<18 years). This study provides a contemporary multicenter understanding of the incidence and risk factors for AdV infection following allo-HCT. Our findings may help optimize infection screening and intervention criteria, particularly for younger at-risk adults.
腺病毒（AdV）是异基因造血干细胞移植（allo-HCT）受者日益受到关注的威胁，尤其是当感染持续且未得到解决时。AdVance 是第一项评估欧洲移植中心儿科和成人 allo-HCT 受者中 AdV 感染发生率的多中心、多国研究。对 50 个参与中心在 2013 年 1 月至 2015 年 9 月期间接受首次 allo-HCT 的患者的病历进行了回顾。allo-HCT 后 6 个月内，使用任何检测方法在任何样本中检测到 AdV 感染的累积发生率在儿科 allo-HCT 受者（n=1736）中为 32%（95%置信区间[CI]，30.9%至 33.4%），在成人 allo-HCT 受者（n=2540）中为 6%（95% CI，4.7%至 6.4%）。AdV 血症≥1000 拷贝/ml（开始预防性治疗的常见阈值）的发生率在儿科受者中为 14%（95% CI，13.0%至 14.8%），在成人受者中为 1.5%（95% CI，1.1%至 2.0%）。发生 AdV 血症≥1000 拷贝/ml 的基线危险因素包括年龄较小、使用 T 细胞耗竭和供体类型不是匹配相关。通过多变量分析，基线人口统计学因素在所有年龄段的患者中基本相似。值得注意的是，AdV 感染的发生率随年龄增长呈逐步下降趋势；年龄较小的成年人（18 至 34 岁）与年龄较大的儿科患者（<18 岁）的发生率相似。这项研究提供了 allo-HCT 后 AdV 感染发生率和危险因素的当代多中心认识。我们的研究结果可能有助于优化感染筛查和干预标准，特别是对于有风险的年轻成年人。
