Blood, 1 September 2002, Vol. 100, No. 5, pp. 1523-1523
Adenovirus infections after BMT
Adenovirus infections are a common complication of allogeneic
hematopoietic transplantation. In many patients, the infections are
self-limited and resolve spontaneously, but in other transplant recipients, adenovirus disease occurs, which is relentlessly
progressive and ultimately fatal. There is no established effective
therapy for adenovirus infection. These infections are related
to posttransplantation immunodeficiency and are most frequent in the
most severely immunocompromised patients. Chakrabarti et al (page 1619)
prospectively examine the incidence and outcome of adenovirus
infections in 76 patients receiving allogeneic hematopoietic
transplants, and they identify risk factors for the development of
these infections and survival. Patients receiving in vivo
alemtuzumab antibody treatment had the highest incidence of
adenovirus infection and disease (45%). These patients also had the
most severe lymphocytopenia. The authors attempted treatment of
adenovirus infections by withdrawal of immunosuppression when possible.
Although all 12 patients who were able to have immunosuppression
withdrawal survived, and all 3 patients who continued
immunosuppressive therapy succumbed to the infection, the later group
likely had ongoing GVHD and were at greater risk for fatal disease.
Since adenoviral disease is related to the severe
posttransplantation immunodeficiency, withdrawal of
immunosuppressive therapy or donor lymphocyte infusion are rational
considerations for therapy. These measures to enhance immune reactivity
also increase the risk of GVHD, particularly early after
transplantation. Controlled studies are needed to demonstrate the
safety and efficacy of this strategy.
Richard Champlin
University of Texas, M.D. Anderson Cancer
Center
