Adenovirus disease after hematopoietic cell transplantation: A Japanese transplant registry analysis

We analyzed a Japanese registry database to elucidate the incidence, risk factors, and outcomes of adenovirus (AdV) disease after autologous and allogeneic hematopoietic cell transplantation (HCT) in contemporary real-world patients. We evaluated the cumulative incidence of AdV disease, as well as risk factors, survival, and treatment details, among 25 233 patients who underwent autologous HCT and 48 380 patients who underwent allogeneic HCT between 2005 and 2019. The 1-year cumulative incidences of AdV disease after autologous and allogeneic HCT were 0.18% and 1.52%, respectively, in children, and 0.49% and 2.99%, respectively, in adults. Among patients with AdV disease, renourinary infection was the most common manifestation, and viremia or disseminated disease occurred in 6% of those after autologous HCT and 19% of those after allogeneic HCT. In multivariate analysis, age >= 50 years and lymphoma were associated with AdV disease after autologous HCT, while patients age >= 50 years, male patients, lymphoma, HCT-specific comorbidity index >= 3, human leukocyte antigen-mismatched or haploidentical donors, cord blood, in vivo T-cell depletion, HCT from 2005 to 2009, acute graft-versus-host disease (GVHD), and chronic GVHD were associated with AdV disease after allogeneic HCT. The 1-year probabilities of survival after disease diagnosis were 65% in autologous HCT and 44% in allogeneic HCT. Regardless of the AdV disease burden, there was an increased risk of mortality after both autologous and allogeneic HCT. The most commonly used antiviral agents were cidofovir and vidarabine. The probabilities of improvement and survival with currently available agents were suboptimal. AdV disease after HCT remains a challenge. Better antiviral modalities are necessary.

Automated summary

This study analyzed a Japanese registry database to investigate the incidence, risk factors, and outcomes of adenovirus (AdV) disease after autologous and allogeneic hematopoietic cell transplantation (HCT). The study found that the incidence of AdV disease was higher in adults compared to children, and higher in allogeneic HCT compared to autologous HCT. Renourinary infection was the most common manifestation of AdV disease, and viremia or disseminated disease occurred more frequently in allogeneic HCT. Age, gender, and lymphoma were associated with AdV disease after HCT. The study also found an increased risk of mortality after both autologous and allogeneic HCT regardless of the AdV disease burden. Currently available antiviral agents showed suboptimal improvement and survival rates. Better antiviral modalities are needed to address the challenge of AdV disease after HCT.