Adenovirus Infection in Patients Undergoing Hematopoietic Stem Cell Transplantation

Adenovirus (AdV) is a relatively common cause of viral infection in the general population, especially in childhood. In patients undergoing hematopoietic stem cell transplantation (HSCT), AdV infections can present as disseminated disease and can be life-threatening. Here, we present a review of AdV infection in the stem cell transplant setting, including AdV clinical presentation, epidemiology, and treatment, with a particular focus on novel virus-specific T cell (VST) therapy.

Safe and effective treatments of AdV infection and disease are lacking; current therapies such as cidofovir are often accompanied by significant toxicity. Most recent advances in the treatment of AdV infection and disease have occurred in the realm of cytotoxic T cell therapy in which AdV is one of many viral targets. Notably, third-party VSTs have been observed to improve AdV viral load and improve disease symptoms without clear evidence for increased graft-versus-host disease risk.

While donor-derived and third-party AdV-targeted VSTs offer promise in the treatment of severe and disseminated AdV infection and disease, randomized-controlled trials are needed to demonstrate VST safety and efficacy in the stem cell transplant population. Despite encouraging findings, questions remain about ideal therapy candidates, donor sources, and combinations of viral targets for effective VST therapy.