Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Successful treatment with plasma exchange for disseminated cidofovir-resistant adenovirus disease in a pediatric SCT recipient

Bone Marrow Transplantation volume 47, pages 1138–1139 (2012)Cite this article

Subjects

Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allo-SCT, and disseminated infection is associated with a high rate of mortality (20–60%),1, 2, 3 particularly in pediatric SCT patients.1, 3 Although antiviral agents are commercially available, of which cidofovir is the most effective, treatment with cidofovir is not always effective against disseminated-AdV infections.4, 5, 6 In some reports, clearance of the virus occurred only when the lymphocytes recovered after SCT.7 To help accelerate the lymphocyte recovery, tapering the immunosuppressant therapy should be attempted.8 However, this is not possible in most cases because of the development of acute GVHD, or even when it is possible, lymphocyte recovery does not always occur. We herein reported a case that developed disseminated-AdV disease after allo-SCT and was successfully treated by plasma exchange (PE) even under lymphopenic conditions.

A 2-year-old boy with ALL in relapse underwent allogeneic BMT from an human leukocyte Ag-matched unrelated donor. The conditioning regimen consisted of fractionated TBI (2 Gy × 6), etoposide (60 mg/kg) × 1 day and CY (60 mg/kg) × 2 days. Tacrolimus and short-term MTX were administered for the prophylaxis of acute GVHD. On day 19 after SCT, myeloid engraftment (ANC >500 cells/μL) was achieved. However, the patient developed grade-III (skin 3, gut 2, liver 0) acute GVHD on day 9, which was barely resolved with 2 mg/kg/day prednisolone and additional administration of MTX (10 mg/m2, on day 28, 31, 35, 42, 51).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Walls T, Shankar AG, Shingadia D . Adenovirus: an increasingly important pathogen in paediatric bone marrow transplant patients. Lancet Infect Dis 2003; 3: 79–86.

    Article  PubMed  Google Scholar 

  2. La Rosa AM, Champlin RE, Mirza N, Gajewski J, Giralt S, Rolston KV et al. Adenovirus infections in adult recipients of blood and marrow transplants. Clin Infect Dis 2001; 32: 871–876.

    Article  CAS  PubMed  Google Scholar 

  3. Baldwin A, Kingman H, Darville M, Foot AB, Grier D, Cornish JM et al. Outcome and clinical course of 100 patients with adenovirus infection following bone marrow transplantation. Bone Marrow Transplant 2000; 26: 1333–1338.

    Article  CAS  PubMed  Google Scholar 

  4. Ljungman P, Ribaud P, Eyrich M, Matthes-Martin S, Einsele H, Bleakley M et al. Cidofovir for adenovirus infections after allogeneic hematopoietic stem cell transplantation: a survey by the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2003; 31: 481–486.

    Article  CAS  PubMed  Google Scholar 

  5. Neofytos D, Ojha A, Mookerjee B, Wagner J, Filicko J, Ferber A et al. Treatment of adenovirus disease in stem cell transplant recipients with cidofovir. Biol Blood Marrow Transplant 2007; 13: 74–81.

    Article  CAS  PubMed  Google Scholar 

  6. Lindemans CA, Leen AM, Boelens JJ . How I treat adenovirus in hematopoietic stem cell transplant recipients. Blood 2010; 116: 5476–5485.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kampmann B, Cubitt D, Walls T, Naik P, Depala M, Samarasinghe S et al. Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation. Br J Hematol 2005; 130: 595–603.

    Article  CAS  Google Scholar 

  8. Chakrabarti S, Mautner V, Osman H, Collingham KE, Fegan CD, Klapper PE et al. Adenovirus infections following allogeneic stem cell transplantation: incidence and outcome in relation to graft manipulation, immunosuppression, and immune recovery. Blood 2002; 100: 1619–1627.

    Article  CAS  PubMed  Google Scholar 

  9. Manzin A, Candela M, Solforosi L, Gabrielli A, Clementi M . Dynamics of hepatitis C viremia after plasma exchange. J Hepatol 1999; 31: 389–393.

    Article  CAS  PubMed  Google Scholar 

  10. Ramratnam B, Bonhoeffer S, Binley J, Hurley A, Zhang L, Mittler JE et al. Rapid production and clearance of HIV-1 and hepatitis C virus assessed by large volume plasma apheresis. Lancet 1999; 354: 1782–1785.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan

    T Nishikawa, K Nakashima, R Fukano, J Okamura & J Inagaki

Authors
  1. T Nishikawa
    View author publications

    Search author on:PubMed Google Scholar

  2. K Nakashima
    View author publications

    Search author on:PubMed Google Scholar

  3. R Fukano
    View author publications

    Search author on:PubMed Google Scholar

  4. J Okamura
    View author publications

    Search author on:PubMed Google Scholar

  5. J Inagaki
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to T Nishikawa.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nishikawa, T., Nakashima, K., Fukano, R. et al. Successful treatment with plasma exchange for disseminated cidofovir-resistant adenovirus disease in a pediatric SCT recipient. Bone Marrow Transplant 47, 1138–1139 (2012). https://doi.org/10.1038/bmt.2011.227

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/bmt.2011.227

Search

Advanced search

Quick links