A clinical algorithm identifies high risk pediatric oncology and bone marrow transplant patients likely to benefit from treatment of adenoviral infection

Kirsten Marie Williams, Allison L. Agwu, Alix A. Dabb, Meghan A. Higman, David M. Loeb, Alexandra Valsamakis, Allen R. Chen

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Adenoviral infections cause morbidity and mortality in blood and marrow transplantation and pediatric oncology patients. Cidofovir is active against adenovirus, but must be used judiciously because of its nephrotoxicity and unclear indications. Therefore, before introducing cidofovir use during an adenoviral outbreak, we developed a clinical algorithm to distinguish low risk patients from those who merited cidofovir therapy because of significant adenoviral disease and high risk for death. OBJECTIVE: This study was conducted to determine whether the algorithm accurately predicted severe adenovirus disease and whether selective cidofovir treatment was beneficial. STUDY DESIGN: A retrospective analysis of a pediatric oncology/blood and marrow transplantation cohort prealgorithm and postalgorithm implementation was performed. Results: Twenty patients with adenovirus infection were identified (14 high risk and 6 low risk). All low-risk patients cleared their infections without treatment. Before algorithm implementation, all untreated high-risk patients died, 4 out of 5 (80%), from adenoviral infection. In contrast, cidofovir reduced adenovirus-related mortality in the high-risk group postalgorithm implementation (9 patients treated, 1 patient died; RR 0.14, P<0.05) and all treated high-risk patients cleared their virus. Conclusions: The clinical algorithm accurately identified patients at high risk for severe fatal adenoviral disease who would benefit from selective use of cidofovir.

Original languageEnglish (US)
Pages (from-to)825-831
Number of pages7
JournalJournal of Pediatric Hematology/Oncology
Volume31
Issue number11
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

Fingerprint

Bone Marrow
Pediatrics
Transplants
Infection
Adenoviridae
Therapeutics
Transplantation
Adenoviridae Infections
Mortality
Disease Outbreaks
cidofovir
Viruses
Morbidity

Keywords

  • Adenovirus algorithm
  • Cidofovir
  • Hematopoietic stem cell transplant
  • Hemolytic-uremic syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

A clinical algorithm identifies high risk pediatric oncology and bone marrow transplant patients likely to benefit from treatment of adenoviral infection. / Williams, Kirsten Marie; Agwu, Allison L.; Dabb, Alix A.; Higman, Meghan A.; Loeb, David M.; Valsamakis, Alexandra; Chen, Allen R.

In: Journal of Pediatric Hematology/Oncology, Vol. 31, No. 11, 01.11.2009, p. 825-831.

Research output: Contribution to journalArticle

Williams, Kirsten Marie ; Agwu, Allison L. ; Dabb, Alix A. ; Higman, Meghan A. ; Loeb, David M. ; Valsamakis, Alexandra ; Chen, Allen R. / A clinical algorithm identifies high risk pediatric oncology and bone marrow transplant patients likely to benefit from treatment of adenoviral infection. In: Journal of Pediatric Hematology/Oncology. 2009 ; Vol. 31, No. 11. pp. 825-831.
@article{71b5108a4e8a472eb6506703019a6693,
title = "A clinical algorithm identifies high risk pediatric oncology and bone marrow transplant patients likely to benefit from treatment of adenoviral infection",
abstract = "Background: Adenoviral infections cause morbidity and mortality in blood and marrow transplantation and pediatric oncology patients. Cidofovir is active against adenovirus, but must be used judiciously because of its nephrotoxicity and unclear indications. Therefore, before introducing cidofovir use during an adenoviral outbreak, we developed a clinical algorithm to distinguish low risk patients from those who merited cidofovir therapy because of significant adenoviral disease and high risk for death. OBJECTIVE: This study was conducted to determine whether the algorithm accurately predicted severe adenovirus disease and whether selective cidofovir treatment was beneficial. STUDY DESIGN: A retrospective analysis of a pediatric oncology/blood and marrow transplantation cohort prealgorithm and postalgorithm implementation was performed. Results: Twenty patients with adenovirus infection were identified (14 high risk and 6 low risk). All low-risk patients cleared their infections without treatment. Before algorithm implementation, all untreated high-risk patients died, 4 out of 5 (80{\%}), from adenoviral infection. In contrast, cidofovir reduced adenovirus-related mortality in the high-risk group postalgorithm implementation (9 patients treated, 1 patient died; RR 0.14, P<0.05) and all treated high-risk patients cleared their virus. Conclusions: The clinical algorithm accurately identified patients at high risk for severe fatal adenoviral disease who would benefit from selective use of cidofovir.",
keywords = "Adenovirus algorithm, Cidofovir, Hematopoietic stem cell transplant, Hemolytic-uremic syndrome",
author = "Williams, {Kirsten Marie} and Agwu, {Allison L.} and Dabb, {Alix A.} and Higman, {Meghan A.} and Loeb, {David M.} and Alexandra Valsamakis and Chen, {Allen R.}",
year = "2009",
month = "11",
day = "1",
doi = "10.1097/MPH.0b013e3181b7873e",
language = "English (US)",
volume = "31",
pages = "825--831",
journal = "Journal of Pediatric Hematology/Oncology",
issn = "1077-4114",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - A clinical algorithm identifies high risk pediatric oncology and bone marrow transplant patients likely to benefit from treatment of adenoviral infection

AU - Williams, Kirsten Marie

AU - Agwu, Allison L.

AU - Dabb, Alix A.

AU - Higman, Meghan A.

AU - Loeb, David M.

AU - Valsamakis, Alexandra

AU - Chen, Allen R.

PY - 2009/11/1

Y1 - 2009/11/1

N2 - Background: Adenoviral infections cause morbidity and mortality in blood and marrow transplantation and pediatric oncology patients. Cidofovir is active against adenovirus, but must be used judiciously because of its nephrotoxicity and unclear indications. Therefore, before introducing cidofovir use during an adenoviral outbreak, we developed a clinical algorithm to distinguish low risk patients from those who merited cidofovir therapy because of significant adenoviral disease and high risk for death. OBJECTIVE: This study was conducted to determine whether the algorithm accurately predicted severe adenovirus disease and whether selective cidofovir treatment was beneficial. STUDY DESIGN: A retrospective analysis of a pediatric oncology/blood and marrow transplantation cohort prealgorithm and postalgorithm implementation was performed. Results: Twenty patients with adenovirus infection were identified (14 high risk and 6 low risk). All low-risk patients cleared their infections without treatment. Before algorithm implementation, all untreated high-risk patients died, 4 out of 5 (80%), from adenoviral infection. In contrast, cidofovir reduced adenovirus-related mortality in the high-risk group postalgorithm implementation (9 patients treated, 1 patient died; RR 0.14, P<0.05) and all treated high-risk patients cleared their virus. Conclusions: The clinical algorithm accurately identified patients at high risk for severe fatal adenoviral disease who would benefit from selective use of cidofovir.

AB - Background: Adenoviral infections cause morbidity and mortality in blood and marrow transplantation and pediatric oncology patients. Cidofovir is active against adenovirus, but must be used judiciously because of its nephrotoxicity and unclear indications. Therefore, before introducing cidofovir use during an adenoviral outbreak, we developed a clinical algorithm to distinguish low risk patients from those who merited cidofovir therapy because of significant adenoviral disease and high risk for death. OBJECTIVE: This study was conducted to determine whether the algorithm accurately predicted severe adenovirus disease and whether selective cidofovir treatment was beneficial. STUDY DESIGN: A retrospective analysis of a pediatric oncology/blood and marrow transplantation cohort prealgorithm and postalgorithm implementation was performed. Results: Twenty patients with adenovirus infection were identified (14 high risk and 6 low risk). All low-risk patients cleared their infections without treatment. Before algorithm implementation, all untreated high-risk patients died, 4 out of 5 (80%), from adenoviral infection. In contrast, cidofovir reduced adenovirus-related mortality in the high-risk group postalgorithm implementation (9 patients treated, 1 patient died; RR 0.14, P<0.05) and all treated high-risk patients cleared their virus. Conclusions: The clinical algorithm accurately identified patients at high risk for severe fatal adenoviral disease who would benefit from selective use of cidofovir.

KW - Adenovirus algorithm

KW - Cidofovir

KW - Hematopoietic stem cell transplant

KW - Hemolytic-uremic syndrome

UR - http://www.scopus.com/inward/record.url?scp=74249091477&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=74249091477&partnerID=8YFLogxK

U2 - 10.1097/MPH.0b013e3181b7873e

DO - 10.1097/MPH.0b013e3181b7873e

M3 - Article

C2 - 19801951

AN - SCOPUS:74249091477

VL - 31

SP - 825

EP - 831

JO - Journal of Pediatric Hematology/Oncology

JF - Journal of Pediatric Hematology/Oncology

SN - 1077-4114

IS - 11

ER -