Characteristics and clinical outcomes of patients with active viral infection treated with VSTs
| Patient ID . | Age at time of 1st infusion (y) . | Diagnosis . | BMT type . | Indication for VSTs . | VST donor . | Target viruses . | Day of infusion (after BMT) . | Virus status at time of infusion (blood) . | Viral treatment (before VSTs) . | VST dose . | Virus outcome (days post VST) . | Adverse events . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 15.86 | HbSS | MSD | EBV-PTLD | HSCT donor | CMV, EBV, adenovirus | Day +84 | EBV 3809 copies/mL | (Rituximab) | 2 × 107/m2 | PR PTLD resolved but recurred EBViremia (peak at 60 d) | Grade 3 transaminitis |
| HSCT donor | EBV∗ | Day +180, 194 | EBV undetectable | (Rituximab) | 2 × 107/m2 div in 2 doses | Sustained remission (low level detection <1000 copies/mL at 2 y not requiring treatment) Last follow-up: 723 d | None | |||||
| 3 | 9.41 | HbSS | 10/10 MUD | Adenovirus viremia and colitis, BK viruria, history of CMV reactivation | Third party (5/10 MMUD) | CMV, EBV, adenovirus | Day +293 | Adenovirus 25 900 copies/mL BKV 3200 copies/mL | Cidofovir (Brincidofovir) | 2 × 107/m2 | PR Transient improvement in viral load and colitis | None |
| Third party (5/10 MMUD) | CMV, EBV, adenovirus | Day +363 | Adenovirus 11 235 copies/mL BKV 10 300 copies/mL CMV undetectable | (Cidofovir) | 2 × 107/m2 | Adenovirus CR (42 d) BK virus PR (downtrending viral load) Last follow-up:154 d | None | |||||
| 4 | 3.68 | HbSS | MSD | CMV viremia, BK cystitis | HSCT donor | CMV, EBV, adenovirus, HHV6, HPIV3, BKV | Day +105 | CMV detectable <1000 copies/mL BKV 3000 copies/mL | Ganciclovir, (Cidofovir, Foscarnet) | 2 × 107/m2 | CMV CR (180 d) Resolution of BK cystitis with continued detectable viruria (peak > 1 × 108 at 27 d, downtrended without further antiviral treatment) Last follow-up:176 d | None |
| 5 | 14.03 | HbSC | MSD | EBV viremia, CMV viremia (below limit of detection) | HSCT donor | CMV, EBV, adenovirus | Day +34 | CMV low level detectable <1000 copies/mL EBV 231 787 copies/mL | Valganciclovir, (Rituximab) | 5 × 106/m2 | EBV CR (10 d) CMV CR (10 d) with intermittent low-level detection (<1000 copies/mL) not requiring treatment Last follow-up:1294 d | Chronic GVHD 2 months post-infusion |
| 7 | 8.94 | HbSS | 5/6 UCBT | Disseminated CMV (stool, urine) | HSCT donor | CMV, EBV, adenovirus | Day +71 | Undetectable | Ganciclovir (Foscarnet) | 5 × 106/m2 | PD initial clearance of CMV and symptoms but subsequently intermittently detectable up to 1376 copies/mL (90 d). Developed CMV retinitis 173 d after VST infusion. | Acute stage 3 skin and stage 1 GI GVHD, resolved with systemic and topical steroids |
| Recent history of CMV retinitis | Third party (3/10 MMUD) | CMV,∗ EBV, adenovirus | Day +285 | Undetectable | Ganciclovir, valganciclovir (foscarnet, intravitreal ganciclovir, immunoglobulin) | 2 × 107/m2 | CMV sustained remission (90 d) Last follow-up: 436 d | None | ||||
| 11 | 3.32 | HbSS | 5/6 UCBT | CMV and adenoviremia | HSCT donor | CMV, EBV, adenovirus, BKV | Day +97 | CMV 10 778 copies/mL Adenovirus 358 copies/mL | Ganciclovir, cidofovir, valganciclovir (foscarnet) | 1 × 107/m2 | CR (90 d) on cidofovir. With intermittent low-level detection (less than quantifiable) for CMV not requiring further treatment Last follow-up: 384 d | None |
| Patient ID . | Age at time of 1st infusion (y) . | Diagnosis . | BMT type . | Indication for VSTs . | VST donor . | Target viruses . | Day of infusion (after BMT) . | Virus status at time of infusion (blood) . | Viral treatment (before VSTs) . | VST dose . | Virus outcome (days post VST) . | Adverse events . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 15.86 | HbSS | MSD | EBV-PTLD | HSCT donor | CMV, EBV, adenovirus | Day +84 | EBV 3809 copies/mL | (Rituximab) | 2 × 107/m2 | PR PTLD resolved but recurred EBViremia (peak at 60 d) | Grade 3 transaminitis |
| HSCT donor | EBV∗ | Day +180, 194 | EBV undetectable | (Rituximab) | 2 × 107/m2 div in 2 doses | Sustained remission (low level detection <1000 copies/mL at 2 y not requiring treatment) Last follow-up: 723 d | None | |||||
| 3 | 9.41 | HbSS | 10/10 MUD | Adenovirus viremia and colitis, BK viruria, history of CMV reactivation | Third party (5/10 MMUD) | CMV, EBV, adenovirus | Day +293 | Adenovirus 25 900 copies/mL BKV 3200 copies/mL | Cidofovir (Brincidofovir) | 2 × 107/m2 | PR Transient improvement in viral load and colitis | None |
| Third party (5/10 MMUD) | CMV, EBV, adenovirus | Day +363 | Adenovirus 11 235 copies/mL BKV 10 300 copies/mL CMV undetectable | (Cidofovir) | 2 × 107/m2 | Adenovirus CR (42 d) BK virus PR (downtrending viral load) Last follow-up:154 d | None | |||||
| 4 | 3.68 | HbSS | MSD | CMV viremia, BK cystitis | HSCT donor | CMV, EBV, adenovirus, HHV6, HPIV3, BKV | Day +105 | CMV detectable <1000 copies/mL BKV 3000 copies/mL | Ganciclovir, (Cidofovir, Foscarnet) | 2 × 107/m2 | CMV CR (180 d) Resolution of BK cystitis with continued detectable viruria (peak > 1 × 108 at 27 d, downtrended without further antiviral treatment) Last follow-up:176 d | None |
| 5 | 14.03 | HbSC | MSD | EBV viremia, CMV viremia (below limit of detection) | HSCT donor | CMV, EBV, adenovirus | Day +34 | CMV low level detectable <1000 copies/mL EBV 231 787 copies/mL | Valganciclovir, (Rituximab) | 5 × 106/m2 | EBV CR (10 d) CMV CR (10 d) with intermittent low-level detection (<1000 copies/mL) not requiring treatment Last follow-up:1294 d | Chronic GVHD 2 months post-infusion |
| 7 | 8.94 | HbSS | 5/6 UCBT | Disseminated CMV (stool, urine) | HSCT donor | CMV, EBV, adenovirus | Day +71 | Undetectable | Ganciclovir (Foscarnet) | 5 × 106/m2 | PD initial clearance of CMV and symptoms but subsequently intermittently detectable up to 1376 copies/mL (90 d). Developed CMV retinitis 173 d after VST infusion. | Acute stage 3 skin and stage 1 GI GVHD, resolved with systemic and topical steroids |
| Recent history of CMV retinitis | Third party (3/10 MMUD) | CMV,∗ EBV, adenovirus | Day +285 | Undetectable | Ganciclovir, valganciclovir (foscarnet, intravitreal ganciclovir, immunoglobulin) | 2 × 107/m2 | CMV sustained remission (90 d) Last follow-up: 436 d | None | ||||
| 11 | 3.32 | HbSS | 5/6 UCBT | CMV and adenoviremia | HSCT donor | CMV, EBV, adenovirus, BKV | Day +97 | CMV 10 778 copies/mL Adenovirus 358 copies/mL | Ganciclovir, cidofovir, valganciclovir (foscarnet) | 1 × 107/m2 | CR (90 d) on cidofovir. With intermittent low-level detection (less than quantifiable) for CMV not requiring further treatment Last follow-up: 384 d | None |
Viruses in bold indicate product specificity for this target virus.
CR, complete remission; Haplo, haploidentical HLA match; PBSCT, peripheral blood stem cell transplant; PR, partial response; SR, sustained remission; UCBT, umbilical cord blood transplant.
Infusion of a different VST product from previous.