Lower respiratory tract respiratory virus infections increase the risk of invasive aspergillosis after a reduced-intensity allogeneic hematopoietic SCT

Abstract

We have analyzed the incidence and risk factors for the occurrence of invasive aspergillosis (IA) among 219 consecutive recipients of an allogeneic hematopoietic SCT after a reduced-intensity conditioning regimen (Allo-RIC). Twenty-seven patients developed an IA at a median of 218 days (range 24-2051) post-Allo-RIC, for a 4-year incidence of 13% (95% confidence interval 4-24%). In multivariate analysis, risk factors for developing IA were steroid therapy for moderate-to-severe graft vs host disease (GVHD) (Hazard Ratio (HR) 2.9, P=0.03), occurrence of a lower respiratory tract infection (LRTI) by a respiratory virus (RV) (HR 4.3, P<0.01) and CMV disease (HR 2.8, P=0.03). Variables that decreased survival after Allo-RIC were advanced disease phase (HR 1.9, P=0.02), steroid therapy for moderate-to-severe GVHD (HR 2.2, P<0.01), not developing chronic GVHD (HR 4.3, P<0.01), occurrence of LRTI by an RV (HR 3.4, P<0.01) and CMV disease (HR 2, P=0.01), whereas occurrence of IA had no effect on survival (P=0.5). Our results show that IA is a common infectious complication after an Allo-RIC, which occurs late post-transplant and may not have a strong effect on survival. An important observation is the possible role of LRTI by conventional RVs as risk factors for IA.

Black hole in the lung

“…This case is in line with the paper by Martino et al 1 and illustrates how influenza virus triggered this rapidly progressive polymicrobial disease in a severely immunocompromised patient with active chronic GVHD late www.nature.com/bmt (3 years) after transplantation. We think it is of great importance to reassess patients clinically and radiologically by CT scan when respiratory symptoms persist despite appropriate treatment.…”

“…We have read with great interest the recent article by Martino et al 1 about lower respiratory tract virus infections as a risk factor for invasive aspergillosis. The established risk factors for aspergillosis in patients after allogeneic hematopoietic SCT (HSCT) include duration of neutropenia, use of steroids, donor type, underlying disease, age, and presence and treatment of GVHD.…”

“…The established risk factors for aspergillosis in patients after allogeneic hematopoietic SCT (HSCT) include duration of neutropenia, use of steroids, donor type, underlying disease, age, and presence and treatment of GVHD. [2][3][4] The authors of this study 1 analyzed the incidence and risk factors for the occurrence of invasive aspergillosis among 219 recipients of allogeneic HSCT after a reduced-intensity conditioning regimen. They showed that steroid therapy for GVHD and the occurrence of a lower respiratory tract infection caused by a respiratory virus were independent risk factors for the development of invasive aspergillosis.…”

Single and Multiple Viral Infections in Lower Respiratory Tract Infection

“…Viral infection is assumed to precede bacterial infections and may generate the environment for bacterial superinfections [15,18,19]. There is also evidence that viral infections make the lower respiratory tract more susceptible for fungal infections [20]. These findings indicate the need to develop new point of care tools for the diagnosis of viral infections and the differentiation from bacterial infections or the diagnosis of viral/bacterial coinfections.…”

Incidence, characteristics and risk factors of marked hyperbilirubinemia after allogeneic hematopoietic cell transplantation with reduced-intensity conditioning

“…14 Galactomannan Platelia assay (Bio-Rad Laboratories, Marnes-La-Coquette, France) in blood samples was routinely performed since 2003. 15 No prophylactic ursodeoxycholic acid or any other agent to prevent liver injury was used in any of the centers during the study period.…”