2346. Adenovirus (ADV) Infection and Disease after Allogeneic Hematopoetic Stem Cell Transplantation (HSCT): Epidemiology and Predictors of Mortality
Session: Poster Abstract Session: Transplant Virology
Saturday, October 29, 2016
Room: Poster Hall
Background: The reported incidence of ADV after HSCT is 5-20% with an associated mortality as high as 75%. There is a lack of consensus on the definitions of ADV infection versus disease and the predictors of mortality.

Methods: We reviewed the records of patients who underwent HSCT at our institution between 2004 and 2014. Clinical characteristics and outcomes in patients who had a positive ADV test post-HSCT were assessed. ADV tests included PCR or culture of blood, respiratory specimens, urine, stool, or tissue and were obtained for suspected viral infection at the discretion of the treating physician.

Results: 46 (1.9%) of 2423 patients who received HSCT during the study period had a positive ADV test. 14 of the 46 cases had transiently positive ADV tests (11 culture, 3 PCR), did not have ADV clinical disease, and had documented alternative diagnoses. Of 32 cases with ADV disease, 20 occurred less than 100 days post-HSCT, 9 underwent cord HSCT, and 19 had acute GVHD grade II-IV at time of ADV diagnosis. 18 of the 32 cases with ADV disease had a serum viral load (VL) ≥105 copies/mL. Common sites of disease were respiratory, gastrointestinal (GI), and urinary tract (GU) [Table]. All cases of pneumonia involved other organs and 90% had viremia ≥105 copies/mL. 5 of the 8 GI cases not involving another organ system had ADV viremia ≤105 copies/mL. The 30-day mortality in the 32 cases of ADV disease was 7 (22%). There was a trend towards increased 30-day mortality associated with multi-organ involvement (OR 3.2, P < 0.2) as well as viremia ≥105 copies/mL (OR 2.3, P < 0.4). 20 patients were treated with cidofovir, 6 also received brincidofovir.

Conclusion: In this cohort, a positive ADV test was not associated with clinical disease in 30% of patients. The incidence of ADV infection and associated mortality is lower than previously reported; ADV disease remains an important cause of morbidity and mortality in HSCT patients.

Sites of ADV Disease

N (%)

VL < 105

VL ≥ 105

Pneumonia +1

10 (31%)

1

9

GI alone

8 (25%)

5

3

GU alone

5 (16%)

3

2

GI + GU

4 (12%)

2

2

Other2

5 (16%)

3

2

1All had involvement of at least 1 additional site

2Hepatitis, nephritis, encephalitis, or viremia alone

Ann E. Woolley, MD1, Kathleen Dunford, BS2, Samuel Cohen, BS3, Daniel Prestes, MD4, Sarah P. Hammond, MD5, Nicolas Issa, MD6, Lindsey R. Baden, MD6 and Francisco M. Marty, MD, FIDSA7, (1)Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (2)Infectious Disease, Dana Farber Cancer Institute, Boston, MA, (3)Medicine - ID, Brigham and Women's Hospital, Boston, MA, (4)Infectious Diseases, Brigham and Women's Hospital/Harvard Medical School, Boston, MA/Hospital Emilio Ribas, Sao Paulo, Brazil/Hospital Sirio Libanes, Sao Paulo, Brazil, Boston, MA, (5)Infectious Diseases, Brigham and Women's Hospital, Boston, MA, (6)Division of Infectious Diseases, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, (7)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA

Disclosures:

A. E. Woolley, None

K. Dunford, None

S. Cohen, None

D. Prestes, None

S. P. Hammond, None

N. Issa, None

L. R. Baden, None

F. M. Marty, Alexion: Scientific Advisor , Consulting fee
Ansun: Investigator , Research support
Astellas: Consultant and Investigator , Consulting fee and Research support
Basilea: Conference speaker , Speaker honorarium
Chimerix: Consultant and Investigator , Consulting fee and Research support
Gilead: Consultant and Investigator , Consulting fee and Research support
GlaxoSmithKline: Consultant and Investigator , Consulting fee and Research grant
LFB, S.A.: Consultant , Consulting fee
Merck: Consultant and Investigator , Consulting fee and Research support
Shire: Consultant and Investigator , Consulting fee and Research support
WHISCON: Investigator , Research support
Pfizer: Course speaker , Speaker honorarium
Fate Therapeutics: Scientific Advisor , Consulting fee

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