Adenoviral infection after allogeneic stem cell transplantation (SCT): report on 130 patients from a single SCT unit involved in a prospective multi center surveillance study

The incidence of adenovirus (AV) infections following SCT was determined in a prospective multicenter trial. Over 1 year, 130 consecutive patients und ergoing allogeneic SCT at Essen University Hospital were included and follo wed for 6 months. Source of stem cells was blood in 68 cases. Fifty-eight p atients had HLA-identical sibling donors. Throat swabs, urine and stool sam ples were screened weekly for AV antigen and DNA by ELISA and nested PCR, r espectively. In 35 cases adenovirus infection was detected. There was no se asonal 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 incide nces 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 in dependent risk factors for AV infection. Eleven patients had AV isolated fr om more than one site and five patients had probable AV disease. We were no t able to identify patients in whom AV infection was the leading cause of d eath. The majority of patients infected with AV suffered from severe acute graft-versus-host disease often accompanied by other opportunistic infectio ns, such as aspergillosis or CMV reactivation. Nineteen out of 36 patients who died during the observation period had AV infection. In summary, AV inf ection after allogeneic SCT was observed in a substantial number of patient s. 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 a n important risk factor for AV infection. Further studies are needed, howev er, before final conclusions on the clinical sequelae of AV infection can b e made and the role of preventive and therapeutic strategies toward AV infe ction after allogeneic SCT can be defined.