Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed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)

How to cite: Cesaro, S.; Porta, F. Adenovirus Infection in Pediatric Hematopoietic Cell Transplantation: A Challenge Still Open for Survival . Preprints 2022, 2022070251 (doi: 10.20944/preprints202207.0251.v1). Cesaro, S.; Porta, F. Adenovirus Infection in Pediatric Hematopoietic Cell Transplantation: A Challenge Still Open for Survival . Preprints 2022, 2022070251 (doi: 10.20944/preprints202207.0251.v1).

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 & PHARMACOLOGY, Pediatrics

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