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Adenovirus Infection in Children with Acute Myeloid Leukemia: A Report from the Canadian Infection in Acute Myeloid Leukemia Research Group.

Renzi, Samuele MD; Ali, Salah MD; Portwine, Carol MD; Mitchell, David MD; Dix, David MBBS; Lewis, Victor MD; Price, Victoria MBBS; Science, Michelle MD; Sung, Lillian MD, PhD
Pediatric Infectious Disease Journal: Post Acceptance: August 10, 2017
doi: 10.1097/INF.0000000000001723
Original Studies: PDF Only

Background: Children with acute myeloid leukemia (AML) are at high risk of life-threatening bacterial and fungal infection. However, little is known about the prevalence or severity of adenovirus infection in this population. Objective was to describe the characteristics, treatments and outcomes of adenovirus infection in children with newly diagnosed AML.

Methods: We performed a retrospective chart review based upon two multi-center cohort studies which focused on identifying risk factors for infection in children with AML. Inclusion criteria were patients with de novo AML who were <= 18 years of age at diagnosis with a clinical specimen positive for adenovirus.

Results: Among the 235 patients with AML, 12 (5.1%) had positive adenovirus testing. The most common site of isolation was stool (n=11, 91.6 %) and the most frequent symptom was diarrhea (n=11, 91.6 %). Two patients received specific treatment for adenovirus, namely intravenous immunoglobulin (IVIG) only in one patient and both IVIG and inhaled ribavirin in a second patient. In 11 patients, adenovirus resolved uneventfully without recurrence including 10 that received no adenovirus-specific therapy. However, one patient developed sepsis syndrome in the setting of disseminated adenoviral infection and died from multi-organ failure.

Conclusion: In children with AML, adenovirus infection was rare and typically not associated with severe disease, even without specific treatment. However, disseminated and fatal disease can occur in this population. Further investigations are needed to identify pediatric AML patients at particular risk for severe adenovirus infection and to determine optimal treatment approaches in these patients.

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