Pulmonary infections in the hematopoietic cell transplant patient

Abstract

Purpose of review Despite progress in the management of pulmonary infections in the hematopoietic cell transplant (HCT) population, substantial diagnostic, and therapeutic uncertainty remains. Recent findings A growing HCT population reflects more transplants and improved long-term survival. We continue to learn about the epidemiologic and prognostic significance of posttransplant pulmonary infections. Mold-active triazoles have removed invasive fungal pneumonia as a barrier to transplant eligibility. Ibrutinib and respiratory viruses are newly recognized risk factors for invasive fungal disease. Prophylaxis has elevated concerns of resistance in invasive fungal species and late onset Cytomegalovirus. The impact of human herpesviruses, community-associated respiratory viruses, and the microbiome is increasingly appreciated. Multiple antiviral therapies are currently in clinical trials and novel molecular diagnostics may improve the performance of bronchoscopy for infectious causes. Summary Fungal and viral pneumonias remain an important cause of morbidity and mortality in the HCT population. Despite our increased understanding of the epidemiology and outcomes of species-specific diagnoses, the utility of invasive diagnostic testing continues to be debated and effective therapies for many clinically relevant pathogens remain limited. Pulmonary infections are a priority for research efforts in this immunocompromised population.

Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies

“…The impact of the COVID‐19 pandemic on haematological patients (HP) is expected to be significant but has not been comprehensively reported to date. Haematological malignancies are a heterogeneous group of diseases with a high risk of bacterial, fungal and viral infections 3‐5 . These infections are related to both the immune dysfunction resulting from the underlying disease and the anti‐tumour therapies used.…”

Metagenomic Next-Generation Sequencing vs. Traditional Pathogen Detection in the Diagnosis of Infection After Allogeneic Hematopoietic Stem Cell Transplantation in Children

“…Immune function of patients will be reduced due to severely lymphopenic, use of immunosuppressant and graft vs. host disease (GVHD) after transplantation, and therefore prone to a more severe course of infections ( Sahin et al, 2016 ). Infections in bloodstream, pulmonary, and central nervous system (CNS) are severe complications with high mortality in allo-HSCT recipients ( Sahin et al, 2016 ; Rosello et al, 2017 ; Young et al, 2017 ; Ford et al, 2020 ; Liu et al, 2021 ). The incidence of various infections varied greatly after allo-HSCT.…”

“…The incidence of various infections varied greatly after allo-HSCT. The pathogens of post-transplantation infections also varied among different reports ( Maschke et al, 1999 ; Roemer et al, 2001 ; Kang et al, 2015 ; Young et al, 2017 ; Zhang et al, 2017 ; Ford et al, 2020 ). These discrepancies are partly due to a variety of testing methods.…”

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

“…Key knowledge gaps, identified in the 2021 National Institute of Health report, included the identification of risk factors for post-HSCT pulmonary complications, standardization of diagnostic techniques, understanding of biology in noninfectious lung injury, therapeutic options for pulmonary dysfunction post HSCT and strategies to improve outcomes for those children requiring critical care management [2 ▪▪ ]. A review published in Current Opinions in Infection Diseases in 2020 [3 ▪▪ ] focused on the spectrum of pulmonary infections in adult HSCT recipients. This review will focus on paediatric HSCT recipients and will summarize recent developments in the diagnosis and prediction of pulmonary complications in this population.…”