Adenovirus infection in adult patients undergoing allogeneic hematopoietic stem cell transplant: incidence, clinical management and outcome.

ABSTRACT Adenovirus infection (ADVi) is an emergent complication in adult patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) yet associated with poor outcome. Available data are scarce with respect to risk factors and proper management of ADVi in adults allo-HSCT, and recommendations on monitoring and preemptive therapy are consequently based on low levels of evidence. The primary aim of the study was to describe incidence of ADVi at day + 180 post-transplant in adult patients who underwent allo-HSCT in our Centre. Secondary objectives were to describe timing, clinical presentation, management and outcome of ADVi and to identify risk factors for ADVi and ADV-related mortality. In our study we analysed a large cohort of 445 adult patients undergoing allo-HSCT. Incidence at day + 180 post-transplant was: ADVi 9% (39/445), ADV viremia (ADVv) 5% (24/445) and ADVv with maximum viral load (VL max) > 10^3 cp/mL 3% (12/445). The median time to ADVi was 65 (IQR 19; 94) days. All patients with ADV VL max > 10^5 cp/mL developed disease and 50 % died. In contrast, no patients with ADV VL < 10^5 cp/mL died with/for ADVi. Overall ADVi related mortality was 1.4% (6/445) in the whole cohort, 18% (6/33) for those with ADVv and 50% (6/12) for ADVv with VL max > 10^5 cp/mL. Conclusion: in our experience ADVi was more frequent than in other cohorts and VL max > 10^5 cp/mL was associated with unfavourable outcome, so careful monitoring and early initiation of treatment are advisable.