Adenovirus Burden in Allogeneic Hematopoietic Stem Cell Transplantation: Monitoring Versus Symptoms-Based Testing-A Cost-Effectiveness Analysis.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-08-08 DOI:10.1111/tid.70089

Estela Giménez, José Luis Piñana, Eliseo Albert, Ignacio Torres, Ariadna Pérez, Juan Carlos Hernández-Boluda, Carlos Solano, David Navarro

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Abstract

Background: Adenovirus infection (AdVi) causes significant morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients.

Methods: This retrospective study of 131 patients (2020-2024) compared systematic monitoring in high-risk patients versus symptom-based testing in standard-risk patients.

Results: The 1-year incidence of AdV DNAemia was 19.8%, with AdV disease at 5.3%, being higher in the routine monitoring cohort (26%) than in the symptom-based cohort (11%, p = 0.031). Neither infection nor monitoring strategy impacted outcomes. The machine learning model identified predictive factors for early AdV DNAemia: age (50-65 years), diagnosis of acute leukemia or myelodysplastic syndrome, transplant from an HLA-matched unrelated or haploidentical donor, and non-myeloablative conditioning. Cost-effectiveness analysis showed that risk-based testing was optimal (€149 per additional detected case), while universal monitoring was excessively costly (€1006 per additional detected case).

Conclusion: In conclusion, although AdVi was common, routine monitoring did not improve outcomes and was financially burdensome, suggesting that a machine learning-driven risk-based testing strategy enhances cost-effectiveness while ensuring timely AdV detection and intervention.

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异基因造血干细胞移植中的腺病毒负担：监测与基于症状的检测-成本-效果分析

背景：腺病毒感染（AdVi）在异基因造血干细胞移植（allogenetic hematopoietic stem cell transplantation, alloo - hct）受者中引起显著的发病率和死亡率。方法：对131例患者（2020-2024年）进行回顾性研究，比较高危患者的系统监测与标准风险患者的基于症状的检测。结果：1年AdV dna血症发生率为19.8%，AdV疾病发生率为5.3%，常规监测组（26%）高于症状组（11%,p = 0.031）。感染和监测策略都没有影响结果。机器学习模型确定了早期AdV dna血症的预测因素：年龄（50-65岁），急性白血病或骨髓增生异常综合征的诊断，来自hla匹配的非亲缘或单倍体相同供体的移植，以及非清髓条件。成本效益分析表明，基于风险的检测是最优的（每新增发现病例149欧元），而普遍监测的成本过高（每新增发现病例1006欧元）。结论：尽管AdVi很常见，但常规监测并没有改善结果，而且在经济上负担沉重，这表明机器学习驱动的基于风险的检测策略可以提高成本效益，同时确保及时发现和干预AdVi。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.