Prospective Study of the Incidence, Clinical Features, and Outcome of Symptomatic Upper and Lower Respiratory Tract Infections by Respiratory Viruses in Adult Recipients of Hematopoietic Stem Cell Transplants for Hematologic Malignancies

Abstract

Respiratory viruses (RVs) are known to be major causes of morbidity and mortality in recipients of hematopoietic stem cell transplants (HSCTs), but prospective long-term studies are lacking. We prospectively screened all adult HSCT recipients (172 allogeneic [alloHSCT] and 240 autologous [autoHSCT]) who underwent transplantation during a 4-year period (1999 to 2003) for the development of a first episode of symptomatic upper respiratory tract infections and/or lower respiratory tract infections (LRTI) by an RV. RVs studied were influenza A and B viruses (n=39), human respiratory syncytial virus (n=19), human adenoviruses (n=11), human parainfluenza viruses 1 to 3 (n=8), human enteroviruses (n=5), human rhinoviruses (n=3), and the recently discovered human metapneumoviruses (n=19). During the study, 51 and 32 cases of RV symptomatic infections were identified of alloHSCT and autoHSCT recipients (2-year incidence, 29% and 14%, respectively). Risk factors for progression of upper respiratory tract infection to LRTI included severe (<0.2x10(9)/L) and moderate (<0.2x10(9)/L) lymphocytopenia in alloHSCT (P=.02) and autoHSCT (P=.03). Death from LRTI was attributed to an RV in 8 alloHSCT recipients. Symptomatic RV had no effect on 2-year outcomes, with the possible exception of influenza A and B virus infections in autoHSCT: these were associated with nonrelapse mortality (P=.02). In conclusion, this prospective trial allows an estimation of the minimum incidence of a first RV infection in adult HSCT recipients and identifies risk factors for acquisition of an RV infection and progression to LRTI; this should aid in the design of future studies. In addition, human metapneumovirus should be added to the potentially serious causes of RV infections in HSCT.

Frequency of human metapneumovirus infection in hematopoietic SCT recipients during 3 consecutive years

“…17,19 With regard to disease severity, progression to pneumonia is frequent and has been more frequently reported in allogeneic than in autologous HSCT recipients with hMPV infection. 6,7 In the present series, 3 of the 11 patients (27.3%) with hMPV infection developed pneumonia. However, we could not establish the role of hMPV in one episode because RSV was also detected in the same BAL sample.…”

“…The present study demonstrated a prevalence rate of 7% of hMPV infection in HSCT recipients with upper respiratory symptoms during 3 consecutive years. In a prospective 4-year study, Martino et al 6 found a 2-year incidence of 5.2 and 3% in allogeneic and autologous HSCT recipients, respectively. In our series, the prevalence rate reached 11% in 2003, probably reflecting greater intensity of hMPV circulation in the community that year.…”

“…Since then, other series have reported the occurrence of hMPV infection in HSCT recipients. In a prospective 4-year study, Martino et al 6 found a 2-year incidence of 5.2 and 3% in allogeneic and autologous HSCT recipients, respectively. Pneumonia caused by hMPV was seen more frequently in allogeneic than in autologous HSCT (44 versus 4%).…”

H1N1 in allogeneic stem cell recipients: courses of infection and influence of vaccination on graft-versus-host-disease (GVHD)

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 H1N1 in allogeneic stem cell recipients: courses of infection and influence of vaccination on graft-versus-host-disease (GVHD) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 It is well known that seasonal influenza causes substantial morbidity and mortality in immunocompromised allogeneic blood stem cell recipients. 1 groups. The experiences demonstrate that by taking all available measures it might be possible to …”

Patient and family education in HSCT: improving awareness of respiratory virus infection and influenza vaccination. A descriptive study and brief intervention

“…1,2 Although the majority are upper respiratory tract infections, [1][2][3][4][5] pneumonia historically occurs in 16-45% of all RV episodes, [1][2][3] and up to 80% of influenza. 6 Early treatment with oseltamavir has been shown to reduce the incidence of pneumonia in cases of influenza to o30% with an associated mortality o10%.…”