Review
Version 1
Preserved in Portico This version is not peer-reviewed
Adenovirus Infection in Pediatric Hematopoietic Cell Transplantation: A Challenge Still Open for Survival
Version 1
: Received: 16 July 2022 / Approved: 18 July 2022 / Online: 18 July 2022 (08:13:46 CEST)
A peer-reviewed article of this Preprint also exists.
Cesaro, S.; Porta, F. Adenovirus Infection in Pediatric Hematopoietic Cell Transplantation: A Challenge Still Open for Survival. J. Clin. Med. 2022, 11, 4827. Cesaro, S.; Porta, F. Adenovirus Infection in Pediatric Hematopoietic Cell Transplantation: A Challenge Still Open for Survival. J. Clin. Med. 2022, 11, 4827.
Abstract
Human Adenovirus (HAdV) infection occurs in 14-16% of patients in the early months after pediatric hematopoietic cell transplantation (HCT) and this correlates with a higher risk to develop HAdV disease and overall 6-month mortality. The main risk factors for HAdV infection are T-cell depletion of the graft by ex vivo CD34+ selection or in vivo use of alemtuzumab or anti-thymocyte serum, the development of grade III-IV graft versus host disease (GVHD), the type of donor (unrelated donor, cord blood, haploidentical or HLA mismatched parent) and severe lymphopenia (< 0.2 x 109/L). The prevention of HAdV disease is based on early intervention with antivirals in the asymptomatic patient when the permitted viral load threshold on blood (> 102-3 copies/ml) and/or on the stool (109 copies/g stool) is exceeded. Cidofovir, a monophosphate nucleotide analog of cytosine, is the primary drug for preemptive therapy, used at 5 mg/kg/week for 2 weeks followed by 3-5 mg/kg every 2 weeks. The alternative schedule is 1 mg/kg every other day (three times/week). Enhancing virus-specific T-cell immunity in the first months post-HCT by donor-derived or third-party-derived virus-specific T cells represents an innovative and promising way of intervention applicable both in prevention and therapeutic setting.
Keywords
adenovirus infection; adenovirus disease; cidofovir; preemptive therapy; risk factors; survival
Subject
Medicine and Pharmacology, Pediatrics, Perinatology and Child Health
Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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