Incidence and outcome of Adenovirus disease in transplant recipients after reduced-intensity conditioning with alemtuzumab
Incidence and outcome of Adenovirus disease in transplant recipients after reduced-intensity conditioning with alemtuzumab
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DOI：
10.1016/j.bbmt.2003.11.001
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发表时间：
2004-03-01
影响因子：
4.3
通讯作者：
MacKinnon, S
中科院分区：
文献类型：
--
作者：
Avivi, I;Chakrabarti, S;MacKinnon, S
腺病毒是异体移植后感染并发症的主要原因。我们评估了86例连续患者阿仑单抗降低强度调理后症状性腺病毒感染或腺病毒疾病的发生率和结局。腺病毒病的总概率为18.4%（11/86例）。5例患者死于进行性腺病毒病，这是该队列中最重要的死亡感染性原因。腺病毒病患者的非复发死亡率为49%，而无腺病毒病患者的非复发死亡率为25.5% （P = 0.007）。淋巴细胞减少的严重程度和免疫抑制治疗的持续是进展性腺病毒疾病和死亡的最重要危险因素。相比之下，未接受免疫抑制治疗或减少或停用免疫抑制治疗的患者清除了病毒。我们还发现，缺乏针对巨细胞病毒再激活的预防性抗巨细胞病毒（CMV）治疗与进展性腺病毒疾病的风险之间存在相关性（P = 0.05）。我们的研究结果强调了腺病毒作为一种重要的移植后病原体的出现，即使是在降低强度条件后，也证明了淋巴细胞减少症的严重程度、抗巨细胞病毒预防和免疫抑制治疗对腺病毒病的结果的影响。(C) 2004年美国血液和骨髓移植学会。
Adenoviruses are emerging as a major cause of infectious complications after allogeneic transplantation. We evaluated the incidence and outcome of symptomatic adenovirus infection or adenovirus disease after alemtuzumab-based reduced-intensity conditioning in 86 consecutive patients. The overall probability of adenovirus disease was 18.4% (11/86 patients). Five patients died of progressive adenovirus disease, and this was the most important infectious cause of mortality in this cohort. The probability of nonrelapse mortality was 49% in patients with adenovirus disease compared with 25.5% in those without (P = .007). The severity of lymphocytopenia and continuation of immunosuppressive therapy were the most important risk factors for progressive adenovirus disease and death. In contrast, patients who were not receiving immunosuppressive therapy or had had it reduced or withdrawn cleared the virus. We also detected a correlation between the lack of preemptive anti-cytomegalovirus (CMV) therapy for CMV reactivation and the risk of progressive adenovirus disease (P = .05). Our findings highlight the emergence of adenovirus as an important posttransplantation pathogen even after reduced-intensity conditioning and demonstrate the effect of the severity of lymphocytopenia, anti-CMV prophylaxis, and immunosuppressive therapy on the outcome of adenovirus disease. (C) 2004 American Society for Blood and Marrow Transplantation.