Impact of Adenovirus Viremia in Bone Marrow Transplant Patients, 2010-2013

Purpose: Recently, the expanded availability of adenovirus PCR assays has allowed the detection of quantitative adenovirus viremia in patients. Few studies have examined the impact of adenovirus viremia in blood or marrow transplant patients and the value of using PCR to detect adenovirus in the blood of these patients.

Methods: This is a case-control study of all adult blood or marrow transplant recipients diagnosed with adenovirus viremia via blood PCR assay at a single university based cancer center from 4/1/2010 to 5/1/2013.   Three controls matched for malignancy, and type and year of transplant were chosen per case. Epidemiologic and clinical data were collected from chart review of identified patients. 

Results: During the study period, 805 patients underwent blood or marrow transplantation; 61% of which were autologous. Five (0.6%) patients developed adenovirus viremia post-transplant at a median of 68 days (range 17-79 days) post-transplant. Table 1 shows the demographic comparison between cases and controls. Cases had significantly higher total bilirubin (1.2 vs 0.6 mg/dL; p=0.003) and ALT levels (71 vs 29 U/L; p=0.03) and lower albumin (2.6 vs 3.7 g/dL; p<0.001). Adenovirus viremia was associated with fever in 80% of patients, hematuria/cystitis in 60%, and sore throat in 40%. Table 2 reports outcomes of cases and controls. Two (40%) of the case patients died; one of sepsis and one of failure to thrive. Cases were more likely to have relapse of their malignancy (80% vs 20%; p=0.03) and BK viruria (80% vs 7%; p=0.03). Table 3 describes the treatment courses of the cases. 

Conclusions: Adenovirus viremia in blood or marrow transplant recipients is rare. The illness may correlate with relapse of malignancy and higher mortality, but larger studies need to be performed to investigate this finding further. Adenovirus viremia also appears to occur more frequently in patients with BK viruria, suggesting it may also be a disease of over immunosuppression.