Landmark AdVance Study Shows Adenovirus Burden Correlates with Mortality in Pediatric Allogeneic Hematopoietic Cell Transplant Recipients
Prior to the AdVance study, the epidemiology of AdV after allo-HCT has been generally understood via single-center studies, with little data on the correlation between AdV viral load and risk of mortality. Historically, acceptance of virologic endpoints as surrogates for clinical outcomes such as survival have been important in progressing antiviral development in other viral diseases.
“AdVance represents a significant step forward in our understanding of the impact of adenovirus on allo-HCT recipients. Although clinicians have long held anecdotal correlations of high adenovirus measures and mortality in the six months after transplant, we now have data from transplant centers across
The AdVance natural history study was a multi-center, multinational analysis conducted in 2017 that examined the incidence, practice patterns, hospitalization and clinical outcomes of 4,276 (1,736 pediatric, 2,540 adults) allo-HCT recipients. At IDWeek in
The statistical analysesexplored the relationship between six different dynamic AdV viral load measures and all-cause mortality, including:
- AdV time-averaged area under the curve (AAUC)
- Peak AdV viremia
- AdV viral load over time
- Two-week change in AdV viremia
- Days of viremia <1,000 copies/mL
- Days of undetectable AdV viremia
Key findings include a greater than ten-fold risk of mortality with highest AdV burden.
- Patients in the highest quartile of AdV AAUC had a mortality hazard ratio of 11.6 relative to those in the lowest quartile, showing that AAUC is a clinically useful indicator for AdV infection outcome.
- Peak AdV viral load and persistence of AdV viremia were associated with stepwise increases in mortality, even after adjusting for immune reconstitution.
- AdV AAUC incorporates both viral peak and persistence, with each log10 increase in AdV AAUC associated with approximately a doubling of mortality risk.
- In multivariate analyses, all AdV viral dynamic measures were shown to be significantly associated with, and independent predictors of, all-cause mortality.
Oral presentation details:
- Abstract Title: Adenovirus Load Dynamics Are Consistently Correlated with Risk of Mortality in Pediatric Allogeneic Hematopoietic Cell Transplant Recipients: Findings from the Landmark AdVance Study (1732)
- Oral Abstract Session: Transplant and Immunocompromised Hosts: Emerging Issues
- Location & Time: Room W 2002;
Saturday, October 6, 2018 ,9:15 a.m. PDT (12:15 p.m. EDT )
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Source: Chimerix, Inc.