Incidence and Outcomes of Adenovirus Infections after Allogeneic Hematopoietic Cell Transplant with Post-Transplant...

Increased risk of viral infections has been reported for post-transplantation cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis. We report the incidence of adenovirus (ADV) viremia, disease, and overall survival by Day (D) +180 post-transplant in a large cohort of adult PTCy recipients routinely monitored by ADV quantitative (q) polymerase chain reaction assay (PCR). This is a retrospective single-center study of adult hematopoietic cell transplantation recipients who received PTCy as GVHD prophylaxis at MSK from 2016 through 2024. ADV qPCR in plasma was done weekly through D +100 and at least biweekly through D +180. Clinically significant ADV viremia (cs-ADV) was defined as two consecutive values ≥1000 copies/mL or ≥one value ≥10,000 copies by D +180. Univariate Cox models were used to define predictors of cs-ADV. Of 412 patients, 38% had HLA haploidentical related donors, and 2.9% received antithymocyte globulin. The cumulative incidence of cs-ADV was 3%. ADV disease developed in 8 of 12 (66.6%) patients with cs-ADV (cystitis 2, colitis 5, >two sites 1). All patients who developed ADV disease had relevant clinical symptoms at the onset of cs-ADV viremia. Three of 12 (25%) patients with cs-ADV died by D +180. Causes of death were GVHD (2 patients) and disease progression (1 patient). ADV contributed to the death of 1 patient with GVHD for an overall ADV-contributory mortality of 0.2%. The incidence of cs-ADV and ADV disease among adult PTCy recipients was 3% and 2% respectively. No death was directly attributed to ADV. Our data suggests that routine ADV testing is not warranted for all adult PTCy recipients. Further studies are needed to identify high-risk groups that may benefit from routine testing.