Association between adenovirus viral load and mortality in pediatric allo-HCT recipients: the multinational AdVance study

Marco Zecca, Robert Wynn, Jean-Hugues Dalle, Tobias Feuchtinger, Enrikas Vainorius, Thomas M. Brundage, Aastha Chandak, Essy Mozaffari, Garrett Nichols, Franco Locatelli

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

This multivariable analysis from the AdVance multicenter observational study assessed adenovirus (AdV) viremia peak, duration, and overall AdV viral burden—measured as time-averaged area under the viremia curve over 16 weeks (AAUC0-16)—as predictors of all-cause mortality in pediatric allo-HCT recipients with AdV viremia. In the 6 months following allo-HCT, 241 patients had AdV viremia ≥ 1000 copies/ml. Among these, 18% (43/241) died within 6 months of first AdV ≥ 1000 copies/ml. Measures of AdV viral peak, duration, and overall burden of infection consistently correlate with all-cause mortality. In multivariable analyses, controlling for lymphocyte recovery, patients with AdV AAUC0-16 in the highest quartile had a hazard ratio of 11.1 versus the lowest quartile (confidence interval 5.3–23.6); for peak AdV viremia, the hazard ratio was 2.2 for the highest versus lowest quartile. Both the peak level and duration of AdV viremia were correlated with short-term mortality, independent of other known risk factors for AdV-related mortality, such as lymphocyte recovery. AdV AAUC0-16, which assesses both peak and duration of AdV viremia, is highly correlated with mortality under the current standard of care. New therapeutic agents that decrease AdV AAUC0-16 have the potential of reducing mortality in this at-risk patient population.
Lingua originaleEnglish
pagine (da-a)1632-1642
Numero di pagine11
RivistaBone Marrow Transplantation
Volume54
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • HSCT

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