Outcome and clinical course of 100 patients with adenovirus infection following bone marrow transplantation

We conducted a retrospective review; of the clinical features and outcome o f adenovirus infection in 572 consecutive patients transplanted in a single centre over a 10 year period, One hundred patients (17%) had a total of 10 5 episodes of adenovirus infection diagnosed at a median of 18 days post tr ansplant (range 2-150 days). The incidence was higher in children than adul ts (21% vs 9%, p < 0,001) and in unrelated donor vs matched sibling donor t ransplants (26% vs 9%, P < 0,001), Diarrhoea and fever were the most common presenting features. Reflecting these symptoms, the most common site of is olation was the stool. Serotypes 1, 2 and 7 were the most frequently seen ( total of 41/68 or 60% of evaluable cases). In six patients (6%) adenovirus infection was the direct cause of death occurring at a median of 72 days po st transplant (range 18-365 days). Five of these six patients had pulmonary involvement and four had associated graft-versus-host disease (GVHD), Thre e further patients were considered to have severe adenoviral disease (total incidence 9%, Isolation of virus from multiple sites correlated with a poo r outcome (P < 0,001), Comorbid viral infection was common in this group wi th 50% of all patients having other viruses isolated (predominantly polyoma virus and cytomegalovirus), We conclude that adenovirus is commonly isolat ed after bone marrow transplant and is a cause of significant morbidity but was a rare cause of mortality (6/572 = 1%) in our patient group as a whole , The relative infrequency of severe infection will make it difficult for t he transplant physician to decide which patients should receive experimenta l antiviral drugs such as ribavirin and cidofovir or immunomodulatory thera py with donor white cell infusions.