Incidence and outcome of Adenovirus disease in transplant recipients after reduced-intensity conditioning with alemtuzumab

被引:72
作者
Avivi, I
Chakrabarti, S
Milligan, DW
Waldmann, H
Hale, G
Osman, H
Ward, KN
Fegan, CD
Yong, K
Goldstone, AH
Limb, DC
MacKinnon, S
机构
[1] UCL Hosp, Dept Haematol, London, England
[2] UCL Hosp, Dept Virol, London, England
[3] Birmingham Heartlands Hosp, Dept Haematol, Birmingham B9 5ST, W Midlands, England
[4] Birmingham Heartlands Hosp, Dept Virol, Birmingham B9 5ST, W Midlands, England
[5] Univ Birmingham, Canc Res UK Inst Canc Studies, Birmingham B15 2TT, W Midlands, England
[6] Univ Oxford, Sir William Dunn Sch Pathol, Oxford OX1 3RE, England
基金
英国医学研究理事会;
关键词
adenovirus; alemtuzumab; reduced-intensity conditioning; lymphocyte recovery;
D O I
10.1016/j.bbmt.2003.11.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Adenoviruses are emerging as a major cause of infectious complications after allogeneic transplantation. We evaluated the incidence and outcome of symptomatic adenovirus infection or adenovirus disease after alemtuzumab-based reduced-intensity conditioning in 86 consecutive patients. The overall probability of adenovirus disease was 18.4% (11/86 patients). Five patients died of progressive adenovirus disease, and this was the most important infectious cause of mortality in this cohort. The probability of nonrelapse mortality was 49% in patients with adenovirus disease compared with 25.5% in those without (P = .007). The severity of lymphocytopenia and continuation of immunosuppressive therapy were the most important risk factors for progressive adenovirus disease and death. In contrast, patients who were not receiving immunosuppressive therapy or had had it reduced or withdrawn cleared the virus. We also detected a correlation between the lack of preemptive anti-cytomegalovirus (CMV) therapy for CMV reactivation and the risk of progressive adenovirus disease (P = .05). Our findings highlight the emergence of adenovirus as an important posttransplantation pathogen even after reduced-intensity conditioning and demonstrate the effect of the severity of lymphocytopenia, anti-CMV prophylaxis, and immunosuppressive therapy on the outcome of adenovirus disease. (C) 2004 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:186 / 194
页数:9
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