Incidence and impact of community respiratory viral infections in post‐transplant cyclophosphamide‐based graft‐versus‐host disease prophylaxis and haploidentical stem cell transplantation

Abstract

Summary Community respiratory viral infections (CRVIs) are associated with pulmonary function impairment, alloimmune lung syndromes and inferior survival in human leucocyte antigen (HLA)‐matched allogeneic haematopoietic stem cell transplant (HCT) recipients. Although the incidence of viral infections in HLA‐haploidentical HCT recipients who receive post‐transplant cyclophosphamide (PTCy)‐based graft‐versus‐host disease (GVHD) prophylaxis is reportedly increased, there are insufficient data describing the incidence of CRVIs and the impact of donor source and PTCy on transplant outcomes. Analysing patients receiving their first HCT between 2012 and 2017 for acute myeloid leukaemia, acute lymphoblastic leukaemia and myelodysplastic syndromes, we describe comparative outcomes between matched sibling transplants receiving either calcineurin‐based GVHD prophylaxis (SibCNI, N = 1605) or PTCy (SibCy, N = 403), and related haploidentical transplants receiving PTCy (HaploCy, N = 757). The incidence of CRVIs was higher for patients receiving PTCy, regardless of donor type. Patients in the HaploCy cohort who developed a CRVI by day +180 had both a higher risk of treatment‐related mortality [hazard ratio (HR) 2⋅14, 99% confidence interval (CI) 1⋅13–4⋅07; P = 0⋅002] and inferior 2‐year overall survival (HR 1⋅65, 99% CI 1⋅11–2⋅43; P = 0⋅001) compared to SibCNI with no CRVI. This finding justifies further research into long‐term antiviral immune recovery, as well as development of preventive and treatment strategies to improve long‐term outcomes in such patients.

T-Cell Depleted Haploidentical Transplantation in Children With Hematological Malignancies: A Comparison Between CD3+/CD19+ and TCRαβ+/CD19+ Depletion Platforms

“…A rapid NK cell reconstitution may prevent infections complications. However, a high incidence of CMV reactivation and other viral complications in haploidentical transplant setting especially when using post-Cy as GvHD prophylaxis has been published ( 38 , 39 ). Infections are the main cause of death apart from relapse in the whole group and still continue being an unsolved clinical problem.…”

Evaluation of pulmonary abnormalities in recipients of hematopoietic cell transplants and cellular therapies

“…69 There may also be an increased risk for GVHD and a decline in pulmonary function in those affected by RVIs. 70,71 RVIs in CAR-T cell recipients are among the most common infections reported after infusion. In a review of 83 CAR-T recipients, 43% of patients had RVIs within the first 28 days of infusion, and 11% between 29 and 90 days after infusion.…”

Haploidentical Stem Cell Transplantation for Acute Myeloid Leukemia: Current Therapies, Challenges and Future Prospective

“…According to the CIBMTR data, relapse remains an important challenge in AML patients who undergo haploidentical allografts. Infection is another challenge following haplo-SCTbased immune tolerance induced either by G-CSF and ATG or by PTCy (57,58,103,104). Here, we discussed the recent emerging strategies for relapse or infection intervention or treatment for AML subjects.…”