Adenovirus Viral Kinetics and Mortality in Ex Vivo T Cell-Depleted Hematopoietic Cell Transplant Recipients With Adenovirus Infection From a Single Center

Background. We report on predictors of adenovirus (ADV) viremia and correlation of ADV viral kinetics with mortality in ex vivo T-cell depleted (TCD) hematopoietic cell transplant (HCT). Methods. T cell-depleted HCT recipients from January 1, 2012 through September 30, 2018 were prospectively monitored for ADV in the plasma through Day (D)+100 posttransplant or for 16 weeks after the onset of ADV viremia. Adenovirus viremia was defined as >= 2 consecutive viral loads (VLs)>= 1000 copies/mL through D+100. Time-averaged area under the curve (AAUC) or peak ADV VL through 16 weeks after onset of ADV viremia were explored as predictors of mortality in Cox models. Results. Of 586 patients (adult 81.7%), 51 (8.7%) developed ADV viremia by D+100. Age<18 years, recipient cytomegalovirus seropositivity, absolute lymphocyte count<300 cells/mu L at D+30, and acute graft-versus-host disease were predictors of ADV viremia in multivariate models. Fifteen (29%) patients with ADV viremia died by D+180; 8 of 15 (53%) died from ADV. Peak ADV VL (hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.52-3.33) and increasing AAUC (HR, 2.95; 95% CI, 1.83-4.75) correlated with mortality at D+180. Conclusions. In TCD HCT, peak ADV VL and ADV AAUC correlated with mortality at D+180. Our data support the potential utility of ADV viral kinetics as endpoints in clinical trials of ADV therapies.