Adenoviral infection after allogeneic stem cell transplantation (SCT):: report on 130 patients from a single SCT unit involved in a prospective multi center surveillance study
Adenoviral infection after allogeneic stem cell transplantation (SCT):: report on 130 patients from a single SCT unit involved in a prospective multi center surveillance study
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DOI：
10.1038/sj.bmt.1703083
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发表时间：
2001-07-01
影响因子：
4.8
通讯作者：
Holler, E
中科院分区：
文献类型：
--
作者：
Runde, V;Ross, S;Holler, E
一项前瞻性多中心试验确定了 SCT 后腺病毒 (AV) 感染的发生率。一年多来，连续 130 名在埃森大学医院接受同种异体 SCT 的患者被纳入研究，并随访了 6 个月。 68例干细胞来源为血液。 58 名患者有 HLA 相同的兄弟姐妹捐赠者。每周分别通过 ELISA 和巢式 PCR 对咽拭子、尿液和粪便样本进行 AV 抗原和 DNA 筛查。 35例检测出腺病毒感染。没有季节性变化。咽拭子检测呈阳性24例，尿液检测呈阳性12例，粪便检测呈阳性11例，累计感染风险为29%。呼吸道、胃肠道和泌尿道 AV 感染的发生率分别为 19%、10% 和 9%，移植后中位（范围）间隔为 44（-2-179）、37（-2-168）和 53（17-153）天后诊断感染。多变量分析发现，供体中存在 AV 抗体和 IV 级急性移植物抗宿主病是 AV 感染的独立危险因素。 11 名患者从多个部位分离出 AV，5 名患者可能患有 AV 疾病。我们无法确定 AV 感染是导致死亡的主要原因的患者。大多数感染 AV 的患者患有严重的急性移植物抗宿主病，通常伴有其他机会性感染，例如曲霉病或巨细胞病毒再激活。观察期间死亡的 36 名患者中有 19 名患有 AV 感染。总之，在大量患者中观察到同种异体 SCT 后出现 AV 感染。除了 SCT 后众所周知的病毒感染危险因素外，我们还能够证明供体 AV 抗体检测呈阳性是 AV 感染的重要危险因素。然而，在对 AV 感染的临床后遗症做出最终结论并确定同种异体 SCT 后针对 AV 感染的预防和治疗策略的作用之前，还需要进一步的研究。
The incidence of adenovirus (AV) infections following SCT was determined in a prospective multicenter trial. Over 1 year, 130 consecutive patients undergoing allogeneic SCT at Essen University Hospital were included and followed for 6 months. Source of stem cells was blood in 68 cases. Fifty-eight patients had HLA-identical sibling donors. Throat swabs, urine and stool samples were screened weekly for AV antigen and DNA by ELISA and nested PCR, respectively. In 35 cases adenovirus infection was detected. There was no seasonal variation. Throat swabs were positive in 24, urine in 12, and stool in 11 cases, resulting in a cumulative risk of infection of 29%. The incidences of AV infection of the respiratory, gastrointestinal and urinary tract were 19%, 10%, and 9%, respectively, and infections were diagnosed after a median (range) interval of 44 (-2-179), 37 (-2-168), and 53 (17-153) days after transplantation. On multivariate analysis, presence of AV antibody in the donor and acute graft-versus-host disease grade IV were found to be independent risk factors for AV infection. Eleven patients had AV isolated from more than one site and five patients had probable AV disease. We were not able to identify patients in whom AV infection was the leading cause of death. The majority of patients infected with AV suffered from severe acute graft-versus-host disease often accompanied by other opportunistic infections, such as aspergillosis or CMV reactivation. Nineteen out of 36 patients who died during the observation period had AV infection. In summary, AV infection after allogeneic SCT was observed in a substantial number of patients. In addition to well-known risk factors for viral infection after SCT we were able to demonstrate that a positive AV antibody test in the donor is an important risk factor for AV infection. Further studies are needed, however, before final conclusions on the clinical sequelae of AV infection can be made and the role of preventive and therapeutic strategies toward AV infection after allogeneic SCT can be defined.