Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation

Adenoviral (ADV) infections are increasingly recognized as a cause of morbi dity and mortality in pediatric hematopoietic stem cell transplantation (HS CT). We reviewed our experience with ADV infections in HSCT patients hospit alized for transplantation at Childrens Hospital Los Angeles January 1998 t hrough December 1998. ADV was detected in 47% of patients, with recipients of HSCT from alternative donors (matched unrelated, unrelated cord, and mis matched related donors) being more frequently culture positive than recipie nts of HSCT from matched siblings (62% versus 27%, P = .04). Detection of A DV from 2 or more sites was associated with organ injury, eg, hemorrhagic c ystitis, enteritis, and hepatitis. Because of the high incidence of ADV cul ture-positive patients and the lack of effective anti-ADV therapy, we initi ated a prospective trial to evaluate cidofovir (CDN) in the treatment of AD V infections in HSCT recipients. Eight patients were enrolled on a dosage s chedule of 1 mg/kg 3 times weekly. All of these patients eventually achieve d long-term viral suppression and clinical improvement, although 6 patients needed prolonged CDV therapy for up to 8 months before CDV could be stoppe d without ADV recurrence. We did not observe dose-limiting nephrotoxicity, and the discontinuation of the drug was not required in any patients. Prosp ective controlled trials to further define the role of CDV in the treatment of ADV infections in HSCT patients are warranted.