Community-Acquired Respiratory Virus Infections: A Threat to Long-Term Survivors After Allogeneic Stem Cell Transplant?

Autores de IIS La Fe

• David Gómez Peregrina

  Autor

• Juan Bautista Montoro Gómez

  Autor

• Pedro Miguel Aparicio Chorao

  Autor

Participantes ajenos a IIS La Fe

• Piñana J.L.
• Carbonell-Asins J.A.
• Pérez A.
• Hernani R.
• Hernández-Boluda J.C.
• Navarro D.
• Solano C.

Grupos

• Hematología y Hemoterapia

Abstract

Background Studies on late community-acquired respiratory virus (CARV) infections in long-term allogeneic hematopoietic stem cell transplantation (allo-HCT) survivors are scarce, creating knowledge gaps on the epidemiology, risk of progression to lower respiratory tract disease (LRTD), and conditions linked to poor outcomes. Methods We included consecutive CARV infection episodes occurring up to 6 months after allo-HCT registered in our database from December 2013 to June 2023 at 2 Spanish transplant centers. Results Among 426 allo-HCT recipients, 1070 CARV episodes were recorded, 791 (74%) with only upper respiratory tract disease (URTD) and 279 (15%) progressing to LRTD, at a median of 18.6 months post-transplant. The most common CARVs were rhinovirus, respiratory syncytial virus (RSV), and influenza. The LRTD progression rate was 26%, with a 4.9% all-cause mortality rate at 100 days post-CARV detection. Risk factors for LRTD progression included graft-versus-host disease prophylaxis (odds ratio [OR] 3.08), corticosteroid use (0.1 to <30 mg/day: OR 2.44; =30 mg/day: OR 5.19), absolute lymphocyte count (ALC) <1 × 10^9/L (OR 1.60), fever at CARV screening (OR 4.27), RSV (OR 2.46), and human metapneumovirus (HMPV) (OR 2.76). Risk factors for 100-day all-cause mortality included human leukocyte antigen (HLA) mismatch (hazard ratio [HR] 2.49); corticosteroid use (0.1 to <30 mg/day: HR 3.87; =30 mg/day: HR 5.77); ALC <1 × 10^9/L (HR 2.44); neutropenia <0.5 × 10^9/L (HR 6.74), and age =40 years (HR 4.85). Conclusions Recipients with profound and prolonged immunosuppression remain at risk for severe CARV infection outcomes late after allo-HCT, necessitating intensive clinical monitoring for respiratory symptoms. © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved.

Keywords

• Adolescent; Adult; Aged; Community-Acquired Infections; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Respiratory Tract Infections; Risk Factors; Spain; Survivors; Transplantation, Homologous; Virus Diseases; Young Adult; corticosteroid; cyclophosphamide; cyclosporine; leukocyte antigen; methotrexate; mycophenolate mofetil; prednisolone; sirolimus; tacrolimus; absolute lymphocyte count; adolescent; adult; age; aged; all cause mortality; allogeneic stem cell transplantation; Article; cohort analysis; community acquired infection; disease exacerbation; female; fever; graft versus host reaction; human; Human metapneumovirus; influenza; lower respiratory tract infection; major clinical study; male; mortality; mortality rate; neutropenia; respiratory syncytial virus infection; Rhinovirus infection; risk factor; screening test; side effect; survivor; threat; viral respiratory tract infection; viral upper respiratory tract infection; advers