1191. Rates and outcomes of Adenovirus viremia in adult and pediatric allogeneic HSCT: High Mortality in T-cell depleted HSCT
Session: Poster Abstract Session: Non-CMV Viruses and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • ADVposter1006YJLfinal-2.pdf (461.6 kB)
  • Background: Adenovirus is frequently recovered from stool cultures of HSCT patients with diarrhea. ADV disease is associated with high mortality. High level or rising ADV viremia is shown to precede development of ADV disease. Since 2006 we have used quantitative ADV PCR for detection of viremia especially in patients with + stool Cx for ADV. We report the outcomes of ADV viremia in pts with pos stool cultures.

    Methods: Prospective observational study of 776 adult and pediatric HSCT at MSKCC from Jan 1, 2006 through Dec 2010. Minimum follow up  3 months.  ADV PCR in whole blood was performed by Viracor. ADV viremia was defined as ≥1 +PCR at >1,000 copies/ml or >2 consecutive +.  Early ADV:  First +PCR <180 days post BMT.

    Results: Of 776 HSCT, 24% were children, 51.5% T-cell depleted (TCD), 80.6% myeloablative (MA), 34% marched related donor, and 29% matched unrelated donor. 9% of adults and 20.7% children had ADV in stool, while ADV viremia developed in and 3.7% and 13.1% respectively. The cumulative incidence at 1 year was 11.3% (95%CI 9-13.6) for +stool and 5.7% (95%CI 4.1-7.4) for viremia.  In pts with + stool, TCD (p=0.007) and pediatric (p=0.07) were associated with viremia. We examined 37 patients [TCD 28 and conventional BMT (cBMT) 9] with viremia. Among the 28 TCD pts, 50% were adults, 71% had early ADV a  median 58 days (range 15-159) post BMT. Max viral load was >1x106 copies/ml  in 36%. Four (20%) pts with early ADV had grade 3-4 GVHD in contrast to 7 (88%) with late ADV. Mortality was attributable to ADV in 9 (32%) pts; 8 (89%) with max VL>106copies/ml. Among the 9 cBMT, 30% were  adults, 78% had MA and  89% had early ADV a median 43 days (range 10-82) post BMT, 87.5% (7/8) had ADV< 106 copies/ml. The rate of grade 3-4 GVHD was 44.4%.  There was no mortality attributable to ADV.

    Conclusion: 1) The cumulative incidence of stool and blood ADV at 1 year were 11.3% and 5.7% respectively.2) TCD was a risk factor for viremia in ADV stool+. 3) ADV attributable mortality was 32% in TCD and 0% in cBMT. 4) A max viral load >106 copies/ml carried a 70% attributable mortality. 5) Screening efforts for early detection of viremia should be focused in TCD HSCT particularly children.  


    Subject Category: O. Transplant infectious diseases

    Yeon Joo Lee, MD, MPH1, Dick Chung, BS1, Zeyar Htun1, Lalitha Parameswaran, MD, MPH1, Trudy Small, MD1, Jenna Goldberg, MD1, Susan Seo, MD1, Junting Zheng1, Glenn Heller1, Ann Jakubowski, MD, PhD1 and Genovefa Papanicolaou, MD2, (1)Memorial Sloan-Kettering Cancer Center, New York, NY, (2)Infectious Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY

    Disclosures:

    Y. J. Lee, None

    D. Chung, None

    Z. Htun, None

    L. Parameswaran, None

    T. Small, None

    J. Goldberg, None

    S. Seo, None

    J. Zheng, None

    G. Heller, None

    A. Jakubowski, None

    G. Papanicolaou, Pfizer: Grant Investigator, Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.