Viral Pneumonia in Patients with Hematopoietic Cell Transplantation and Hematologic Malignancies

Abstract

Viral pneumonia is a common complication for patients with hematologic malignancies and after hematopoietic cell transplantation causing significant morbidity, and often mortality. Infections are predominantly caused by herpes viruses, either by reactivation of latent infection, or less commonly primary infection, or community respiratory viruses. High-resolution CT scan is useful for diagnosis but is nonspecific; generally, bronchoalveolar lavage is required. Prevention strategies are not pathogen-specific but include vaccination, chemoprophylaxis, preemptive treatment, and effective infection-prevention strategies during community outbreaks. Directed antiviral treatment is available for some pathogens. Toxicities and viral resistance are perennial challenges.

Influenza and Viral Pneumonia

“…25,26 It is not unusual for the infection to present in a disseminated form in these patients, and pneumonia is one of the complications. [25][26][27]…”

Morbidity and Mortality Associated With Respiratory Virus Infections in Allogeneic Hematopoietic Cell Transplant: Too Little Defense or Harmful Immunity?

“…Influenza is diagnosed in approximately 1–5% of HCT recipients, and in up to 33% of patients with respiratory symptoms in the flu-season. Progression to viral pneumonia occurs in 14–30% of patients, and is associated with mortality in 10–28% (Fisher et al, 2017 ; Green, 2017 ). These numbers are strongly influenced by seasonal outbreaks and the subtype of the influenza virus.…”

“…CARV infections range from asymptomatic carriership to significant respiratory disease. Prevalence of CARV largely depends on season, detection mode, age of patient and immune status (Shah et al, 2012 ; Hirsch et al, 2013 ; Green, 2017 ). Influenza and RSV have significant seasonal variation, whereas Para influenza or rhinovirus cause disease year round (Green, 2017 ).…”

“…Prevalence of CARV largely depends on season, detection mode, age of patient and immune status (Shah et al, 2012 ; Hirsch et al, 2013 ; Green, 2017 ). Influenza and RSV have significant seasonal variation, whereas Para influenza or rhinovirus cause disease year round (Green, 2017 ). Highly sensitive diagnostic techniques like polymerase chain reaction (PCR) for the detection of viral DNA and RNA reveal a high prevalence of CARV in the normal population.…”

“…Only few groups looked at long term outcome. Results are conflicting, reported risk of progression is 5–75% (Bredius et al, 2004 ; Hirsch et al, 2013 ; Chemaly et al, 2014b ; Fisher et al, 2017 ; Green, 2017 ). HCT is a curative treatment for several malignant and non-malignant childhood diseases.…”