1536. Adenovirus Disease in Patients with Multiple Myeloma After Autologous Stem Cell Transplantation
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_Poster_9-27-2013. Final.pdf (158.9 kB)
  • Background:

    Adenovirus disease in not well described in the autologous stem cell transplant (ASCT) setting. Herein, we describe a single-institution experience of adenovirus disease in patients with hematological malignancies undergoing ASCT.

    Methods:

    This is an IRB approved retrospective analysis, involving reviewing medical records of 924 patients with hematologic malignancies undergoing ASCT between August 2009 and August 2012 to identify patients with Adenovirus disease. Adenovirus disease was defined as symptomatic illness involving end-organs along with viremia (> 100 DNA copies/ml) documented > 2 times over a period of ten days, with or without isolation of the virus by PCR from respiratory, urine and stool specimens. At our institution adenovirus plasma PCR is not a standard surveillance test and testing is initiated due to clinical symptoms. Commercially available Adenovirus quantitative plasma Polymerase Chain Reaction (PCR) test by ViraCor-IBT was used as the diagnostic tool. Adenovirus reactivation was defined as positive PCR >100 DNA copies/ml without clinical symptoms.

    Results:

    13 (1.4%) patients were found to have adenovirus reactivation by plasma PCR. Five of the13 patients (0.05%) had clinical symptoms (all with multiple myeloma). One patient developed an acute febrile illness day 33 post-ASCT requiring hospitalization, but the episode resolved without any treatment. 4 patients had multi-organ involvement with high grade viremia, 2 (40% with clinical disease) patients died during that hospitalization. Two patients made full recovery and were discharged from hospital (post- ASCT). Treatment was given with Cidofovir and Intra Venous Immunoglobulin to all 4 patients. All patients had a CD4 count <200 obtained with 30 days of the episode. Co-infections with bacterial and other viral pathogens were seen 60% (3/5) patients.

    Conclusion:

    This is the largest review of ASCT cases documenting Adenovirus disease. Although disseminated Adenovirus disease is most commonly seen in allogeneic stem cell transplant patients, most cases presented with disseminated disease associated with high morbidity and mortality. In our experience viral load corresponded to the severity of illness and the diseases carried high mortality despite adequate systemic treatment.

    Zainab Shahid, M.D.1, Naveen Sanath kumar, M.D1, Senu Apewokin, MD1, Alejandro Restrepo, M.D.1, Monica Grazziutti, MD1, Elias Anaissie, MD2, Saad Usmani, M.D.3 and Bart Barlogie, MD, PhD1, (1)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR, (2)University of Arkansas for Medical Sciences, Little Rock, AR, (3)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Services, Little Rock, AR

    Disclosures:

    Z. Shahid, None

    N. Sanath kumar, None

    S. Apewokin, None

    A. Restrepo, None

    M. Grazziutti, None

    E. Anaissie, None

    S. Usmani, None

    B. Barlogie, None

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