RESUMEN
Background: Adenovirus [Ad] infections have delayed clearance in paediatric patients. The immune suppression that occurs after hematopoietic stem cell transplantation [HSCT] can reactivate adenovirus, resulting in life-threatening disseminated disease
Aim of the work: to assess adenovirus infection in recipients of bone marrow transplantation and to find out if there is an association between adenovirus infection and the occurrence of graft versus host disease [GVHD] in these patients
Patients and methods: The study was conducted on 30 pediatric patients admitted to Nasser institute, for bone marrow transplantation. Serum and stool samples were collected one day prior to bone marrow transplantation, and every one or two weeks afterwards till the patient completed 100 days after HSCT. The adenoviral DNA was monitored in the patient's serum and stool samples by quantitative real time polymerase chain reaction [qPCR]. The stool samples that tested positive for the presence of adenovirus were processed by cell culture technique for isolation of the virus
Results: Adenoviral DNA was detected in the fecal samples of 11 out of 30 patients [36.6% of cases]; the viral load ranged from 1.2 X 10[³] copies/gram, to 8.4 X 10[7] copies per gram, two patients had 2 positive stool samples with rising titer indicating the reactivation of the adenovirus. The adenoviral DNA was detected in the serum samples of only two patients [6.6% of cases], with a low titer, one of them was only 500 copies/ml and the other one was 1.6 X 10[4] copies /ml. The remaining serum samples of the patients who shed the adenovirus in their stool were all negative for adenoviral DNA. These two patients, who had Ad DNA in their serum, had no adenoviral shedding in their stool. The adenovirus reactivation was not associated with increased risk of developing GVHD, diarrhea or CMV reactivation
Conclusion: although the adenovirus was shed in the stool of 9 patients, the viral shedding was not associated with increased risk of developing GVHD, diarrhea or CMV reactivation
RESUMEN
The Eastern Mediterranean Bone Marrow Transplantation [EMBMT] Group has accumulated over 25 years of data and experience in hematopoietic stem cell transplantation [HSCT], most particularly in he-moglobinopathies, severe aplastic anemia [SAA], and inherited metabolic and immune disorders, in addition to hematologic malignancies peculiar to the region and where recent updates in trends in activities are warranted. To study trends in HSCT activities in the World Health Organization-Eastern Mediterranean [EM] region surveyed by EMBMT between 2008 and 2009. STUDY DESIGN: Retrospective analysis of the survey data, mainly of the cumulative number of transplants, types of transplants [autologous vs. allogeneic], types of conditioning as myeloablative [MAC] vs. reduced intensity conditioning [RIC] and trends in leukemias, hemo-globinopathies, SAA, inherited bone marrow failure syndromes amongst others. Fourteen teams from ten Eastern Mediterranean Region Organization [EMRO] countries reported their data [100% return rate] to the EMBMT for the years 2008-2009 with a total of 2608 first HSCT [1286 in 2008; 1322 in 2009]. Allogeneic HSCT represented the majority [63%] in both years. The main indications for allogeneic HSCT were acute leukemias [732; 44%], bone marrow failure syndromes [331, 20%], hemoglobinopathies [255; 15%] and immune deficiencies [90; 5%]. There was a progressive increase in the proportions of chronic myeloid leukemia [CML] cases transplanted beyond the first chronic phase [3; 7% of all CML cases in 2008 vs 13; 29% in 2009]. The main indications for autologous transplants were plasma cell disorders [345; 36%] Hodgkin disease [256; 27%], non-Hodgkin lymphoma [207; 22%] and solid tumors [83; 9%]. RIC continued to show a progressive increase over the years [7% in 2007, 11% in 2008 and 13% in 2009], yet remained relatively low compared to contemporary practices in Europe published by EBMT. The vast majority [95%] of allo-HSCT sources were from sibling donors with a continued dominance of peripheral blood [PB] [1076; 63%], while cord blood transplant [CBT] increased to 83 [5% of allo-HSCT], matched unrelated donor [MUD] remained underutilized [1; 0%] and there were no haploidentical transplants reported. Large centers with >50 HSCT/year showed a plateau of the total number of allo-HSCT over the last 5 years that may be related to capacity issues and needs further study. There is an overall increased rate of HSCT in the EMRO region with a significant increase in utilization of CBT and allogeneic PB-HSCT as a valuable source. However, further research on outcome data and development of regional donor banks [CB and MUD] may help facilitate future planning to satisfy the regional needs and increase collaboration within the group and globally