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.