Community‐acquired respiratory virus lower respiratory tract disease in allogeneic stem cell transplantation recipient: Risk factors and mortality from pulmonary virus‐bacterial mixed infections

Abstract

Risk factors (RFs) and mortality data of community-acquired respiratory virus (CARVs) lower respiratory tract disease (LRTD) with concurrent pulmonary co-infections in the setting of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is scarce. From January 2011 to December 2017, we retrospectively compared the outcome of allo-HSCT recipients diagnosed of CARVs LRTD mono-infection (n = 52, group 1), to those with viral, bacterial, or fungal pulmonary CARVs LRTD co-infections (n = 15, group 2; n = 20, group 3, and n = 11, group 4, respectively), and with those having bacterial pneumonia mono-infection (n = 19, group 5). Overall survival (OS) at day 60 after bronchoalveolar lavage (BAL) was significantly higher in group 1, 2, and 4 compared to group 3 (77%, 67%, and 73% vs 35%, respectively, P = .012). Recipients of group 5 showed a trend to better OS compared to those of group 3 (62% vs 35%, P = .1). Multivariate analyses showed bacterial co-infection as a RF for mortality (hazard ratio[HR] 2.65, 95% C.I. 1.2-6.9, P = .017). We identified other 3 RFs for mortality: lymphocyte count <0.5 × 10 /L (HR 2.6, 95% 1.1-6.2, P = .026), the occurrence of and CMV DNAemia requiring antiviral therapy (CMV-DNAemia-RAT) at the time of BAL (HR 2.32, 95% C.I. 1.1-4.9, P = .03), and the need of oxygen support (HR 8.3, 95% C.I. 2.9-35.3, P = .004). CARV LRTD co-infections are frequent and may have a negative effect in the outcome, in particular in the context of bacterial co-infections.

The effect of timing on community acquired respiratory virus infection mortality during the first year after allogeneic hematopoietic stem cell transplantation: a prospective epidemiological survey

“…Among the other variables associated with higher mortality in the current study, we confirm that LRTD and lymphopenia remain the most important and validated risk factors for mortality after CARV infection in the allo-HCT setting [4][5][6][7]. Besides these, use of ATG showed a direct association with mortality in both overall CARV and those limited to the LRTD.…”

“…Established and validated risk factors for progression from upper respiratory tract disease (URTD) to lower respiratory tract disease (LRTD) and mortality include recipient age, smoking history, high APACHE II score, lymphopenia, high-dose total body irradiation, high-dose steroids, and presence of copathogens [4][5][6][7][8]. Validated risk scores have recently been proposed to predict respiratory syncytial virus (RSV) and influenza virus infections with greater accuracy [1,[9][10][11][12][13].…”

Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs

“…Importantly, a number of studies have now investigated the association of Basel immunodeficiency grades and MD Anderson ISI scores in HCT and hematologic malignancy patients not only for HRSV but also for IV-A/B, HPIV, and other CARV infections (27,73,76,77,107,111). Some of these studies include side-by-side comparisons (77,78). Indeed, many of the parameters present in the SID grades and ISI overlap and permit separation of patients into groups of similar clinical outcomes regarding progression from upper to lower RTID or mortality (Fig.…”

Community acquired respiratory virus infections in adult patients undergoing umbilical cord blood transplantation

“…Respiratory co-infection was defined as the identification of significant microbiological agents in the same sample as previously defined [7].…”

“…Upper and/or lower respiratory tract disease (URTD/LRTD) due to community-acquired respiratory viruses (CARVs) represent a significant cause of morbidity and mortality in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) [1][2][3][4][5][6][7][8]. Decreased absolute lymphocyte count (ALC) at the time of CARV infection is probably the main negative prognostic factor for progression to LRTD and is associated with an increased mortality after allo-HSCT [6,7,9,10]. With this in mind, we can hypothesize that CARV infections in the umbilical cord blood transplantation (UCBT) setting, which is associated with delayed T-cell immune reconstitution, could be associated with greater morbidity and mortality than with other modalities of allo-HSCT.…”