Risk factors for mortality after respiratory syncytial virus lower respiratory tract infection in adults with hematologic malignancies

Vakil, Erik; Sheshadri, Ajay; Faiz, Saadia A.; Shah, Dimpy P.; Zhu, Yichen; Li, Liang; Kmeid, Joumana; Azzi, Jacques; Balagani, Amulya; Bashoura, Lara; Ariza-Heredia, Ella J.; Chemaly, Roy F.

doi:10.1111/tid.12994

Cited by 29 publications

(36 citation statements)

References 31 publications

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“…Independent risk factors for morbidity and mortality were CARV infection within 60 days of HCT, need for respiratory support, and steroid administration within 1 week of RTID (74). Together, various factors reflecting impaired immune control were linked to progression to lower RTID and mortality, in line with the notion that vulnerability to CARVs extends beyond day ϩ100 and may be approximated by clinical and laboratory parameters attempting to capture the degree of vulnerability as either immunodeficiency grading (moderate, severe, and very severe) or as immunodeficiency score index (27,66,(75)(76)(77)(78) (Table 2). A few studies have compared both tools (73,77,78) and found a significant overlap in predicting progression to HRSV lower RTID and mortality despite the fact that only portions of the parameters were identical.…”

Section: General Aspects Of Carvs In the Transplant Populationmentioning

confidence: 80%

“…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.…”

Section: Human Pneumo-and Paramyxoviridaementioning

confidence: 99%

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

2019

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SUMMARY Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.

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Section: General Aspects Of Carvs In the Transplant Populationmentioning

confidence: 80%

Section: Human Pneumo-and Paramyxoviridaementioning

confidence: 99%

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

2019

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“…This score demonstrated value in predicting LRTD progression [1,10] and mortality [10] in the context of influenza respiratory infection and RSV [13]. However, the failure to differentiate risk of mortality between the moderate-risk and low-risk ISI category [10,13] indicates room for improvement. In the meantime, the high-risk ISI category could be useful to assess the severity of several CARV types with LRTD involvement.…”

Section: Discussionmentioning

confidence: 99%

“…ISI was developed by investigators from the MD Anderson Cancer Center to predict outcome in allo-HCT recipients with RSV [9]. This score demonstrated value in predicting LRTD progression [1,10] and mortality [10] in the context of influenza respiratory infection and RSV [13]. However, the failure to differentiate risk of mortality between the moderate-risk and low-risk ISI category [10,13] indicates room for improvement.…”

Section: Discussionmentioning

confidence: 99%

“…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]. Despite the suspicion in real life practice that the timing of CARV infection after allo-HCT could be related to increased severity and mortality, there is a lack of strong evidence supporting this belief.…”

Section: Introductionmentioning

confidence: 99%

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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

Piñana

Pérez

Montoro

et al. 2019

Bone Marrow Transplant

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The effect of timing of community acquired respiratory virus (CARV) infection after allogeneic hematopoietic stem cell transplant (allo-HCT) is an as yet unsettled issue. We evaluate this issue by including all consecutive allo-HCT recipients with molecularly-documented CARV infection during the first year after transplant. The study cohort was drawn from a prospective longitudinal survey of CARV in allo-HCT recipient having respiratory symptoms conducted from December 2013 to December 2018 at two Spanish transplant centers. Respiratory viruses in upper and/or lower respiratory specimens were tested using multiplex PCR panel assays. The study cohort comprised 233 allo-HCT recipients with 376 CARV infection episodes diagnosed during the first year after allo-HCT. Overall, 60% of CARV episodes occurred within the first 6 months (227 out of 376). Thirty patients (13%) had died at 3 months after CARV detection, of which 25 (83%) were recipients developing CARV within the first 6 months after transplant. Multivariate analysis identified four risk factors for mortality: ATG used as part of conditioning regimen [odds ratio (OR) 2.8, 95% confidence interval (C.I.) 1.21-6.4, p = 0.01], CARV lower respiratory tract disease (OR 3.4, 95% C.I. 1.4-8.4, p = 0.007), CARV infection within the first 6 months of transplant (OR 3.04, 95% C.I. 1.1-8.7, p = 0.03), and absolute lymphocyte count <0.2 × 109/L (OR 2.4, 95% C.I. 1-5.3, p = 0.04). Developing CARV infection within the first 6 months was associated with higher mortality. Our data supports that the timing of CARV development after allo-HCT could be of major interest.These authors contributed equally:

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Lack of clinical significance for molecular detection of respiratory viruses in bronchoalveolar lavage samples

Recio

Lalueza

Moral

et al. 2021

Journal of Medical Virology

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The clinical significance of molecular detection of respiratory viruses in bronchoalveolar lavage (BAL) samples is poorly defined. We performed an observational retrospective study including all patients who underwent a BAL procedure in our institution, regardless of the reason for bronchoscopy, from January 2015 to December 2018. Respiratory viruses were detected by real‐time polymerase chain reaction with a commercial multiplex panel, and a cell culture was performed to detect cytomegalovirus and herpes simplex virus. Positive results were correlated with clinical symptoms and patients' characteristics. Of 540 BAL samples analyzed, 113 (20.9%) were positive for any respiratory virus. Viral detection was significantly associated with respiratory symptoms (83.2% vs. 68.9%, p = .004) and radiological infiltrates (67.3% vs. 52.2%, p = .006). The most frequent viruses detected were rhinovirus (42/113, 37.2%), influenza virus (20/113, 17.7%), and parainfluenza virus (PIV) (16/113, 14.2%). Respiratory pathogens codetections were found in 51/113 (45.1%) BAL samples, including more than one virus (16/51, 31.4%), fungi (8/51, 15.7%), and bacteria (9/51, 17.6%). Viral detection was significantly higher in immunocompromised patients (26.5% vs. 16.9%; p = .022). PIV and human metapneumovirus were mostly observed in lung (50.0%, 8/16) and hemopoietic transplant recipients (25%, 2/8), respectively, with clinical repercussions. Our data underline that molecular diagnosis allows identification of viral agents as the etiology of respiratory infections; however, the high frequency of codetections hinders identification of the agent responsible for the current respiratory symptomatology. Immunocompromised patients are the target population in whom to investigate the presence of respiratory viruses in their BAL samples.

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Risk factors for mortality after respiratory syncytial virus lower respiratory tract infection in adults with hematologic malignancies

Abstract: Mortality is similarly high among HM patients without HCT and HCT recipients. High-grade immunodeficiency and detection of RSV from BAL fluid are associated with higher 60-day mortality.

Cited by 29 publications

References 31 publications

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

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

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

Lack of clinical significance for molecular detection of respiratory viruses in bronchoalveolar lavage samples

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