Disseminated adenovirus infection is a complication with a relatively high mortality rate among patients undergoing hematopoietic stem cell transplantation. The low efficacy and poor availability of current treatment options are of major concern. Programmed cell death 1 (PD-1) blockade has been used to treat several chronic viral infections. Herein, we report a case of disseminated adenovirus infection in the early posttransplant period. The patient was diagnosed with diffuse large B-cell lymphoma at first and underwent 8 cycles of chemotherapy, including rituximab. She was subsequently diagnosed with acute myeloid leukemia and received haploidentical transplantation. She was diagnosed with Epstein‒Barr virus (EBV)-positive posttransplant lymphoproliferative disorder (PTLD) 2 months after the transplant, and 3 doses of rituximab were administered. The patient was diagnosed with disseminated adenovirus infection with upper respiratory tract, gastrointestinal tract and blood involved at 3 months after transplantation. She was first treated with a reduction in immunosuppression, cidofovir and ribavirin. Then, the patient received salvage treatment with the PD-1 inhibitor sintilimab (200 mg) after achieving no response to conventional therapy. The adenovirus was cleared 3 weeks later, and concomitant EBV was also cleared. Although the patient developed graft-versus-host disease of the liver after the administration of the PD-1 inhibitor, she was cured with steroid-free therapy. Therefore, PD-1 blockade immunotherapy can be considered a promising treatment option for patients with disseminated adenovirus infection after transplantation, with fully weighing the hazards of infection and the side effects of this therapy.

中文翻译：

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PD-1 阻断免疫疗法作为同种异体造血干细胞移植后播散性腺病毒感染的成功挽救治疗


播散性腺病毒感染是造血干细胞移植患者死亡率相对较高的并发症。当前治疗方案的低疗效和可用性差是主要问题。程序性细胞死亡 1 （PD-1） 阻断已用于治疗多种慢性病毒感染。在此，我们报告了一例移植后早期播散性腺病毒感染病例。患者最初诊断为弥漫性大 B 细胞淋巴瘤，并接受了 8 个周期的化疗，包括利妥昔单抗。她随后被诊断出患有急性髓性白血病并接受了半相合移植。移植后 2 个月，她被诊断为 Epstein\u2012Barr 病毒 （EBV） 阳性移植后淋巴组织增生性疾病 （PTLD），并给予了 3 剂利妥昔单抗。患者移植后 3 个月诊断为播散性腺病毒感染，累及上呼吸道、胃肠道和血液。她首先接受了减少免疫抑制、西多福韦和利巴韦林的治疗。然后，患者在对常规治疗无反应后接受 PD-1 抑制剂信迪利单抗 （200 mg） 的挽救治疗。腺病毒在 3 周后被清除，伴随的 EBV 也被清除。尽管患者在服用 PD-1 抑制剂后患上了肝脏移植物抗宿主病，但她通过无类固醇治疗治愈了。因此，PD-1 阻断免疫疗法可以被认为是移植后播散性腺病毒感染患者的一种有前途的治疗选择，充分权衡了感染的危害和这种疗法的副作用。