The First Affiliated Hospital of Soochow University, National clinical research center for hematologic diseases, Jiangsu Institute of Hematology, 188 Shizi Street, Suzhou, 215006, China.
Soochow Hopes Hematonosis Hospital, Suzhou, 215006, China.
J Hematol Oncol. 2024 May 20;17(1):34. doi: 10.1186/s13045-024-01557-2.
Disseminated adenovirus infection is a complication with a relatively high mortality rate among patients undergoing hematopoietic stem cell transplantation. The low efficacy and poor availability of current treatment options are of major concern. Programmed cell death 1 (PD-1) blockade has been used to treat several chronic viral infections. Herein, we report a case of disseminated adenovirus infection in the early posttransplant period. The patient was diagnosed with diffuse large B-cell lymphoma at first and underwent 8 cycles of chemotherapy, including rituximab. She was subsequently diagnosed with acute myeloid leukemia and received haploidentical transplantation. She was diagnosed with Epstein‒Barr virus (EBV)-positive posttransplant lymphoproliferative disorder (PTLD) 2 months after the transplant, and 3 doses of rituximab were administered. The patient was diagnosed with disseminated adenovirus infection with upper respiratory tract, gastrointestinal tract and blood involved at 3 months after transplantation. She was first treated with a reduction in immunosuppression, cidofovir and ribavirin. Then, the patient received salvage treatment with the PD-1 inhibitor sintilimab (200 mg) after achieving no response to conventional therapy. The adenovirus was cleared 3 weeks later, and concomitant EBV was also cleared. Although the patient developed graft-versus-host disease of the liver after the administration of the PD-1 inhibitor, she was cured with steroid-free therapy. Therefore, PD-1 blockade immunotherapy can be considered a promising treatment option for patients with disseminated adenovirus infection after transplantation, with fully weighing the hazards of infection and the side effects of this therapy.
播散性腺病毒感染是造血干细胞移植患者中死亡率相对较高的并发症。目前治疗选择的疗效低和可用性差是主要关注点。程序性细胞死亡 1 (PD-1) 阻断已被用于治疗几种慢性病毒感染。在此，我们报告了一例移植后早期播散性腺病毒感染的病例。该患者最初被诊断为弥漫性大 B 细胞淋巴瘤，接受了 8 个周期的化疗，包括利妥昔单抗。随后，她被诊断为急性髓系白血病，并接受了单倍体相合移植。移植后 2 个月，她被诊断为 EBV 阳性移植后淋巴组织增生性疾病 (PTLD)，并给予了 3 剂利妥昔单抗。移植后 3 个月，患者被诊断为上呼吸道、胃肠道和血液受累的播散性腺病毒感染。她首先接受了减少免疫抑制、更昔洛韦和利巴韦林治疗。然后，在常规治疗无效后，患者接受了 PD-1 抑制剂信迪利单抗（200mg）的挽救治疗。3 周后，腺病毒被清除，同时 EBV 也被清除。尽管患者在接受 PD-1 抑制剂后发生了肝移植物抗宿主病，但她在无激素治疗后痊愈。因此，PD-1 阻断免疫疗法可被视为移植后播散性腺病毒感染患者有前途的治疗选择，充分权衡感染的危害和这种治疗的副作用。
