1
|
Epstein DJ, Otoukesh S, Shahid Z, Dadwal SS. Infectious Disease Considerations in Chronic Graft-versus-Host Disease and Transplantation Survivors. Transplant Cell Ther 2024; 30:S534-S547. [PMID: 39370235 DOI: 10.1016/j.jtct.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/25/2024] [Indexed: 10/08/2024]
Abstract
Chronic graft-versus-host disease is a frequent and serious complication of allogeneic hematopoietic cell transplantation and is associated with an increased risk of serious infections. Impaired humoral immunity increases the risk of recurrent or severe sinopulmonary infections, and functional asplenia predisposes to infections from encapsulated organisms. Herpesvirus infections and community-acquired respiratory viral infections are problematic as well. Pneumocystis pneumonia remains a risk, and mold infections occur in some patients. Understanding the epidemiology and pathophysiology of these infections is important for determining optimal monitoring and prophylaxis, and guiding patient counseling.
Collapse
Affiliation(s)
- David J Epstein
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.
| | - Salman Otoukesh
- Department of Hematology and HCT, City of Hope National Medical Center, Philadelphia, Pennsylvania
| | - Zainab Shahid
- Division of Infectious Disease, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Ubamadu E, Betancur E, Gessner BD, Menon S, Vroling H, Curcio D, Rozenbaum M, Kurosky SK, Aponte Z, Begier E. Respiratory Syncytial Virus Sequelae Among Adults in High-Income Countries: A Systematic Literature Review and Meta-analysis. Infect Dis Ther 2024; 13:1399-1417. [PMID: 38789901 PMCID: PMC11219677 DOI: 10.1007/s40121-024-00974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) can cause severe respiratory infections in adults; however, information on associated sequelae is limited. This systematic literature review aimed to identify sequelae in adults within 1 year following RSV-related hospitalization or resolution of acute infection. METHODS Studies were identified from Embase, MEDLINE, LILACS, SciELO, and grey literature. Random-effects meta-analyses using restricted maximum likelihood were used to calculate the proportions and relative risks of sequelae in patients with RSV compared with controls (patients with RSV-negative influenza-like illness, influenza, and parainfluenza) per follow-up period, population, and treatment setting, where possible. RESULTS Twenty-one relevant studies covering the period from 1990 to 2019 were included. Among the general population, the most frequent clinical sequela was sustained function loss (33.5% [95% CI 27.6-39.9]). Decline in lung function and cardiovascular event or congestive heart failure were also identified. Utilization sequelae were readmission (highest at > 6 months after discharge) and placement in a skilled nursing facility. The only subpopulation with data regarding sequelae was transplant patients. Among lung transplant patients, the most frequently reported clinical sequelae were decline in lung function, followed by graft dysfunction and bronchiolitis obliterans syndrome. Pooled relative risks were calculated for the following sequela with controls (primarily influenza-positive patients): cardiovascular event (general population) and pulmonary impairment (hematogenic-transplant patients) both 1.4 (95% CI 1.0-2.0) and for readmission (general population) 1.2 (95% CI 1.1-1.3). CONCLUSIONS Although less data are available for RSV than for influenza or other lower respiratory tract infections, RSV infection among adults is associated with medically important sequelae, with a prevalence similar to other respiratory pathogens. RSV sequelae should be included in disease burden estimates.
Collapse
Affiliation(s)
- Egbe Ubamadu
- P95 Pharmacovigilance and Epidemiology, Louvain, Belgium
| | | | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA, USA
- Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Ireland
| | - Sonia Menon
- P95 Pharmacovigilance and Epidemiology, Louvain, Belgium
| | - Hilde Vroling
- P95 Pharmacovigilance and Epidemiology, Louvain, Belgium
| | - Daniel Curcio
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA, USA
- Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Ireland
| | - Mark Rozenbaum
- Value and Evidence, Patient and Health Impact, Pfizer Inc., Capelle a/d Ijssel, The Netherlands
| | - Samantha K Kurosky
- Value and Evidence, Patient and Health Impact, Pfizer Inc., New York, NY, USA
| | - Zuleika Aponte
- P95 Pharmacovigilance and Epidemiology, Louvain, Belgium
| | - Elizabeth Begier
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA, USA.
- Pfizer Vaccines, 9 Riverwalk, Citywest Business Campus, Dublin 24, Ireland.
| |
Collapse
|
3
|
Riccò M, Parisi S, Corrado S, Marchesi F, Bottazzoli M, Gori D. Respiratory Syncytial Virus Infections in Recipients of Bone Marrow Transplants: A Systematic Review and Meta-Analysis. Infect Dis Rep 2024; 16:317-355. [PMID: 38667752 PMCID: PMC11050314 DOI: 10.3390/idr16020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infections. Usually associated with infants and children, an increasing amount of evidence suggests that RSV can cause substantial morbidity and mortality in immunocompromised individuals, including recipients of bone marrow transplantation (BMT). The present systematic review was therefore designed in accordance with the PRISMA guidelines to collect available evidence about RSV infections in BMT recipients. Three medical databases (PubMed, Embase, and MedRxiv) were therefore searched for eligible observational studies published up to 30 September 2023 and collected cases were pooled in a random-effects model. Heterogeneity was assessed using I2 statistics. Reporting bias was assessed by means of funnel plots and regression analysis. Overall, 30 studies were retrieved, including 20,067 BMT cases and 821 RSV infection episodes. Of them, 351 were lower respiratory tract infections, and a total of 78 RSV-related deaths were collected. A pooled attack rate of 5.40% (95% confidence interval [95%CI] 3.81 to 7.60) was identified, with a corresponding incidence rate of 14.77 cases per 1000 person-years (95%CI 9.43 to 20.11), and a case fatality ratio (CFR) of 7.28% (95%CI 4.94 to 10.60). Attack rates were higher in adults (8.49%, 95%CI 5.16 to 13.67) than in children (4.79%, 95%CI 3.05 to 7.45), with similar CFR (5.99%, 95%CI 2.31 to 14.63 vs. 5.85%, 95%CI 3.35 to 10.02). By assuming RSV attack rates as a reference group, influenza (RR 0.518; 95%CI 0.446 to 0.601), adenovirus (RR 0.679, 95%CI 0.553 to 0.830), and human metapneumovirus (RR 0.536, 95%CI 0.438 to 0.655) were associated with a substantially reduced risk for developing corresponding respiratory infection. Despite the heterogeneous settings and the uneven proportion of adult and pediatric cases, our study has identified high attack rates and a substantial CFR of RSV in recipients of BMT, stressing the importance of specifically tailored preventive strategies and the need for effective treatment options.
Collapse
Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
4
|
El Chaer F, Kaul DR, Englund JA, Boeckh M, Batista MV, Seo SK, Carpenter PA, Navarro D, Hirsch HH, Ison MG, Papanicolaou GA, Chemaly RF. American Society of Transplantation and Cellular Therapy Series: #7 - Management of Respiratory Syncytial Virus Infections in Hematopoietic Cell Transplant Recipients. Transplant Cell Ther 2023; 29:730-738. [PMID: 37783338 DOI: 10.1016/j.jtct.2023.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy (ASTCT) partnered with its Transplant Infectious Disease Special Interest Group (TID-SIG) to update the 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A new approach was adopted to better serve clinical providers by publishing each standalone topic in the infectious disease series in a concise format of frequently asked questions (FAQ), tables, and figures. Experts in HCT and infectious diseases identified FAQs and then provided answers based on the strength of the recommendation and the level of supporting evidence. In the seventh guideline in the series, we focus on the respiratory syncytial virus (RSV) with FAQs addressing epidemiology, clinical diagnosis, prophylaxis, and treatment. Special consideration was given to RSV in pediatric, cord blood, haploidentical, and T cell-depleted HCT and chimeric antigen receptor T cell therapy recipients, as well as to identify future research directions.
Collapse
Affiliation(s)
- Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia.
| | - Daniel R Kaul
- Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington
| | - Michael Boeckh
- Clinical Research and Vaccine and Infectious Disease Divisions, Fred Hutchinson Cancer Center and Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Marjorie V Batista
- Department of Infectious Diseases, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Susan K Seo
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, and Department of Microbiology, School of Medicine, University of Valencia, Valencia & Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans H Hirsch
- Clinical Virology Laboratory, Laboratory Medicine, University Hospital Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Michael G Ison
- Respiratory Disease Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
5
|
Matsui T, Ogimi C. Risk factors for severity in seasonal respiratory viral infections and how they guide management in hematopoietic cell transplant recipients. Curr Opin Infect Dis 2023; 36:529-536. [PMID: 37729657 DOI: 10.1097/qco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Seasonal respiratory virus infections (RVIs) often progress to severe diseases in hematopoietic cell transplant (HCT) recipients. This review summarizes the current evidence on risk factors for the severity of RVIs in this high-risk population and provides clinical management. RECENT FINDINGS The likelihood of the respiratory viral disease progression depends on the immune status of the host and the type of virus. Conventional host factors, such as the immunodeficiency scoring index and the severe immunodeficiency criteria, have been utilized to estimate the risk of progression to severe disease, including mortality. Recent reports have suggested nonconventional risk factors, such as hyperglycemia, hypoalbuminemia, prior use of antibiotics with broad anaerobic activity, posttransplant cyclophosphamide, and pulmonary impairment after RVIs. Identifying novel and modifiable risk factors is important with the advances of novel therapeutic and preventive interventions for RVIs. SUMMARY Validation of recently identified risk factors for severe RVIs in HCT recipients is required. The development of innovative interventions along with appropriate risk stratification is critical to improve outcomes in this vulnerable population.
Collapse
Affiliation(s)
- Toshihiro Matsui
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| |
Collapse
|
6
|
Piñana JL, Pérez A, Chorão P, Guerreiro M, García-Cadenas I, Solano C, Martino R, Navarro D. Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances. Transpl Infect Dis 2023; 25 Suppl 1:e14117. [PMID: 37585370 DOI: 10.1111/tid.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Before the COVID-19 pandemic, common community-acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well-being of allogeneic hematopoietic cell transplant (allo-HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo-HCT recipients, face when infected with SARS-CoV-2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo-HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo-HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
Collapse
Affiliation(s)
- Jose L Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Navarro
- Microbiology department, Hospital Clinico Universitario de Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| |
Collapse
|
7
|
Bondeelle L, Giannotti F, Chalandon Y, Le Goff J, Tapparel C, Bergeron A. Bronchiolitis obliterans syndrome following SARS-CoV-2 infection in an allogeneic hematopoietic stem cell recipient. Am J Transplant 2023:S1600-6135(23)00358-1. [PMID: 36972802 PMCID: PMC10039781 DOI: 10.1016/j.ajt.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023]
Abstract
Peripheral allogeneic hematopoietic stem cell transplant (HSCT) recipients are the most vulnerable patients to community-acquired respiratory viruses (CARV) such as respiratory syncytial virus, influenza virus or others. These patients are likely to develop severe acute viral infections; CARVs have also been identified as triggers of bronchiolitis obliterans (BO). BO is a manifestation of pulmonary graft-versus-host disease (GVHD), most often leading to irreversible ventilatory impairment. To date, there are no data on whether SARS CoV2 could be a trigger for BO. Here, we report the first report of a case of BOS following SARS-CoV-2 infection occurring 10 months after allogeneic HSCT with a flare of underlying extra thoracic GVHD. This observation provides a new perspective and should be of particular interest to clinicians, suggesting the need for close monitoring of PFTs after SARS CoV-2 infection. The mechanisms leading to BOS after SARS-CoV-2 infection require further investigation.
Collapse
Affiliation(s)
- Louise Bondeelle
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland.
| | - Federica Giannotti
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Yves Chalandon
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Jerome Le Goff
- Laboratoire de Virologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Caroline Tapparel
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | - Anne Bergeron
- Pneumology Department, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
8
|
Brugière O, Bergeron A, Le Pavec J. [Lung transplantation for chronic graft-versus-host disease after hematopoietic stem cell transplantation]. Rev Mal Respir 2023; 40 Suppl 1:e69-e72. [PMID: 36682955 DOI: 10.1016/j.rmr.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- O Brugière
- Service de pneumologie, hôpital Foch, Suresnes, France.
| | - A Bergeron
- Hôpitaux universitaires de Genève, Genève, Suisse; Université de Paris, UMR 1153 CRESS, biostatistics and clinical epidemiology research team, Paris, France
| | - J Le Pavec
- Service de pneumologie et transplantation pulmonaire, groupe hospitalier Marie-Lannelongue -Saint Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, groupe hospitalier Marie-Lannelongue -Saint Joseph, Le Plessis-Robinson, France
| |
Collapse
|
9
|
Seki M, Hashimoto K, Kondo N, Ohya Y, Kotajima F, Mitsutake K. Sequential Treatment by Antiviral Drugs Followed by Immunosuppressive Agents for COVID-19 Patients with Hematological Malignancy. Infect Drug Resist 2022; 15:7117-7124. [PMID: 36506836 PMCID: PMC9733686 DOI: 10.2147/idr.s393198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background The detailed treatment regimen of COVID-19 patients with hematological malignancies has been unclear, and some fatalities have occurred, although combination therapy with antiviral agents and corticosteroids has been established for moderate to severe COVID-19 patients. Case Series Case 1 was a 57-year-old woman who had malignant lymphoma and received CHOP therapy with obinutuzumab, and case 2 was a 70-year-old-man who had myeloma and received molecular targeted therapy with weekly corticosteroid. In both cases, SARS-CoV-2 genes and antigens were detected from their nasal swabs, and treatment was started for moderate to severe COVID-19. Case 1 received antiviral agents with high doses of corticosteroids for a long term simultaneously, but the high titer of viral antigens in her nasal swabs persisted. Ground-glass opacities and interstitial shadows also worsened in both lungs, and she finally died on day 60. In contrast, in case 2, antiviral agents were started first, and restarted the immunosuppressive agents, such as gamma globulin and corticosteroids after no titer of SARS-CoV-2 antigens was confirmed. The patient survived, and his abnormal chest shadows showed gradual improvement. Both of the patients received two vaccinations, but showed the low antibody titers for SARS-CoV-2. Conclusion Administration of both antiviral agents and corticosteroids has been recommended for moderate to severe COVID-19 patients, but in patients with hematological malignancies, it might be better to use antiviral agents first to reduce the viral titers, and then add steroid and related immunosuppressive agents later appropriately to inhibit the excessive inflammatory state. The dose, timing, and order of the antivirals and immunosuppressive agents for COVID-19 should be considered carefully in the patients with hematological malignancies who showed low vaccine effectiveness.
Collapse
Affiliation(s)
- Masafumi Seki
- Division of Infectious Diseases and Infection Control, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan,COVID-19 Management Team, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan,Correspondence: Masafumi Seki, Division of Infectious Diseases and Infection Control, International Medical Center, Saitama Medical University, Yamane 1397-1, Hidaka City, Saitama, 350-1298, Japan, Tel +81-42-984-4392, Fax +81-42-984-0280, Email
| | - Kosuke Hashimoto
- COVID-19 Management Team, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan
| | - Nami Kondo
- COVID-19 Management Team, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan
| | - Yoshitaka Ohya
- COVID-19 Management Team, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan
| | - Futoshi Kotajima
- COVID-19 Management Team, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan
| | - Kotaro Mitsutake
- Division of Infectious Diseases and Infection Control, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan,COVID-19 Management Team, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan
| |
Collapse
|
10
|
Epstein DJ, Liang EC, Sharifi H, Lai YK, Arai S, Graber-Naidich A, Sundaram V, Nelson J, Hsu JL. Epidemiology of Lower Respiratory Tract Infections and Community-Acquired Respiratory Viruses in Patients with Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation: A Retrospective Cohort Study. Transplant Cell Ther 2022; 28:705.e1-705.e10. [PMID: 35872303 PMCID: PMC9547900 DOI: 10.1016/j.jtct.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bronchiolitis obliterans syndrome (BOS)-chronic graft-versus-host disease (cGVHD) affecting the lungs-is an uncommon complication of allogeneic hematopoietic cell transplant (HCT). The epidemiology and complications of lower respiratory tract infections (LRTIs) and community-acquired respiratory viruses (CARVs) in these patients are poorly understood. OBJECTIVES We aim to characterize the epidemiology of LRTIs in patients with BOS complicating HCT. We also aim to explore the association of LRTIs and CARV detection on lung function in BOS patients. STUDY DESIGN Adult patients with BOS at Stanford Health Care between January 2010 and December 2019 were included in this retrospective cohort study. LRTI diagnosis was based on combined clinical, microbiologic, and radiographic criteria, using consensus criteria where available. RESULTS Fifty-five patients with BOS were included. BOS was diagnosed at a median of 19.2 (IQR 12.5-24.7) months after HCT, and patients were followed for a median of 29.3 (IQR 9.9-53.2) months from BOS diagnosis. Twenty-two (40%) patients died after BOS diagnosis; 17 patients died from complications of cGVHD (including respiratory failure and infection) and 5 died from relapsed disease. Thirty-four (61.8%) patients developed at least one LRTI. Viral LRTIs were most common, occurring in 29 (52.7%) patients, primarily due to rhinovirus. Bacterial LRTIs-excluding Nocardia and non-tuberculous mycobacteria (NTM)-were the second most common, occurring in 21 (38.2%) patients, mostly due to Pseudomonas aeruginosa. Fungal LRTIs, NTM, and nocardiosis occurred in 14 (25.5%), 10 (18.2%), and 4 (7.3%) patients, respectively. Median time to development of the first LRTI after BOS diagnosis was 15.3 (4.7-44.7) months. Twenty-six (76.5%) of the 34 patients who developed LRTIs had infections due to more than one type of organism-fungi, viruses, Nocardia, NTM, and other bacteria-over the observation period. Patients with at least one LRTI had significantly lower forced expiratory volume in one second percent predicted (FEV1%) (37% vs. 53%, p = 0.0096) and diffusing capacity of carbon monoxide (DLCO) (45.5% predicted vs. 69% predicted, p = 0.0001). Patients with at least one LRTI trended toward lower overall survival (OS) (p = 0.0899) and higher non-relapse mortality (NRM) (p = 0.2707). Patients with a CARV detected or LRTI diagnosed after BOS-compared to those without any CARV detected or LRTI diagnosed-were more likely to have a sustained drop in FEV1% from baseline of at least 10% (21 [61.8%] versus 7 [33.3%]) and a sustained drop in FEV1% of at least 30% (12 [36.4%] versus 2 [9.5%]). CONCLUSIONS LRTIs are common in BOS and associated with lower FEV1%, lower DLCO, and a trend toward decreased OS and higher NRM. Patients with LRTIs or CARVs (even absent lower respiratory tract involvement) were more likely to have substantial declines in FEV1% over time than those without. The array of organisms-including P. aeruginosa, mold, Nocardia, NTM, and CARVs-seen in BOS reflects the unique pathophysiology of this form of cGVHD, involving both systemic immunodeficiency and structural lung disease. These patterns of LRTIs and their outcomes can be used to guide clinical decisions and inform future research.
Collapse
Affiliation(s)
- David J Epstein
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.
| | - Emily C Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Husham Sharifi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yu Kuang Lai
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sally Arai
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Anna Graber-Naidich
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Vandana Sundaram
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California; Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Joanna Nelson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Joe L Hsu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
11
|
Graft-versus-host disease may cause pulmonary restriction, but not all restriction is graft-versus-host disease. Blood Adv 2022; 6:4984-4986. [PMID: 35793452 PMCID: PMC9631650 DOI: 10.1182/bloodadvances.2022008201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
|
12
|
Sacks NC, Healey BE, Raza S, Cyr PL, Boerner G, Sheshadri A. The economic burden of NIPC and BOS following allogeneic HSCT in patients with commercial insurance in the United States. Blood Adv 2022; 6:1566-1576. [PMID: 34807973 PMCID: PMC8905687 DOI: 10.1182/bloodadvances.2021004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022] Open
Abstract
Noninfectious pulmonary complications (NIPC) after allogeneic hematopoietic stem cell transplantation (alloHSCT), including bronchiolitis obliterans syndrome (BOS), cause significant morbidity and mortality, but their impact on health care resource utilization (HRU) and costs is unknown. This longitudinal retrospective study quantified the economic burden of NIPC and BOS in alloHSCT patients using commercial claims data from the IQVIA PharMetrics Plus database. Study patients were aged 0 to 64 years and underwent alloHSCT between 1 January 2006 and 30 September 2018, and were observable 12 months before and up to 5 years after index alloHSCT. NIPC patients were identified using International Classification of Disease (ICD) diagnosis codes. Outcomes were mean per patient HRU (inpatient admissions, outpatient office, hospital visits, and prescription medications) and costs paid by insurers in each post-transplant year. Among 2162 alloHSCT patients, 254 developed NIPCs, and 155 were propensity score (PS)-matched to non-NIPC patients. The year following transplantation, NIPC patients had significantly higher inpatient admission rates (3.8 ± 3.2 vs non-NIPC: 2.6 ± 2.4; P < .001) and higher total costs ($567 870 vs $412 400; P = .07), reflecting higher costs for inpatient admissions ($452 475 vs $300 202; P = .06). Among those observable for more years, costs remained higher for NIPC patients, reflecting significantly higher inpatient admission rates in the first 3 years following transplant. Subanalysis of patients with diagnoses likely reflective of BOS were consistent with these findings. AlloHSCT patients who developed NIPC had higher health care resource utilization and incurred higher costs compared with alloHSCT patients who did not develop NIPC following transplant.
Collapse
Affiliation(s)
- Naomi C. Sacks
- Precision Health Economics and Outcomes Research, Boston, MA
- Tufts University School of Medicine, Boston, MA
| | | | - Sajjad Raza
- Precision Health Economics and Outcomes Research, Boston, MA
| | - Philip L. Cyr
- Precision Health Economics and Outcomes Research, Boston, MA
- College of Health and Human Services, University of North Carolina, Charlotte, NC
| | - Gerhard Boerner
- Breath Therapeutics, GmbH, a Zambon company, Munich, Germany; and
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
13
|
José RJ, Dickey BF, Sheshadri A. Airway disease in hematologic malignancies. Expert Rev Respir Med 2022; 16:303-313. [PMID: 35176948 PMCID: PMC9067103 DOI: 10.1080/17476348.2022.2043746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/15/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Hematologic malignancies are cancers of the blood, bone marrow and lymph nodes and represent a heterogenous group of diseases that affect people of all ages. Treatment generally involves chemotherapeutic or targeted agents that aim to kill malignant cells. In some cases, hematopoietic stem cell transplantation (HCT) is required to replenish the killed blood and stem cells. Both disease and therapies are associated with pulmonary complications. As survivors live longer with the disease and are treated with novel agents that may result in secondary immunodeficiency, airway diseases and respiratory infections will increasingly be encountered. To prevent airways diseases from adding to the morbidity of survivors or leading to long-term mortality, improved understanding of the pathogenesis and treatment of viral bronchiolitis, BOS, and bronchiectasis is necessary. AREAS COVERED This review focuses on viral bronchitis, BOS and bronchiectasis in people with hematological malignancy. Literature was reviewed from Pubmed for the areas covered. EXPERT OPINION Airway disease impacts significantly on hematologic malignancies. Viral bronchiolitis, BOS and bronchiectasis are common respiratory manifestations in hematological malignancy. Strategies to identify patients early in their disease course may improve the efficacy of treatment and halt progression of lung function decline and improve quality of life.
Collapse
Affiliation(s)
- Ricardo J José
- Department of Respiratory Medicine, Host Defence, Royal Brompton Hospital, Chelsea, London, UK
- Centre for Inflammation and Tissue Repair, UCL Respiratory, London, UK
| | - Burton F Dickey
- Department of Pulmonary Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW During much of the COVID-19 pandemic, respiratory viruses other than SARS-CoV-2 did not infect immunocompromised patients. As mitigation strategies lighten, there has been a rapid resurgence of respiratory viruses globally. This review will summarize our current options for the management of the common respiratory viruses in transplant recipients. RECENT FINDINGS Expansion of the availability and increased utilization of multiplex molecular assays have allowed the recognition of the scope of respiratory virus infections in the transplant populations. New antivirals for influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV) and adenovirus show promise to improve outcomes of these important infections. SUMMARY Several new antiviral agents, including combination therapy of oseltamivir as well as baloxavir for influenza, fusion and nucleoprotein inhibitors for RSV, DAS181 for PIV and brincidofovir for adenovirus, hold promise to speed clearance of the virus, improve clinical outcomes and reduce the risk of resistance emergence.
Collapse
|
15
|
Chemaly RF, Marty FM, Wolfe CR, Lawrence SJ, Dadwal S, Soave R, Farthing J, Hawley S, Montanez P, Hwang J, Ho JHC, Lewis S, Wang G, Boeckh M. DAS181 Treatment of Severe Lower Respiratory Tract Parainfluenza Virus Infection in Immunocompromised Patients: A Phase 2 Randomized, Placebo-Controlled Study. Clin Infect Dis 2021; 73:e773-e781. [PMID: 33569576 PMCID: PMC8326557 DOI: 10.1093/cid/ciab113] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are no antiviral therapies for parainfluenza virus (PIV) infections. DAS181, a sialidase fusion protein, has demonstrated activity in in vitro and in animal models of PIV. METHODS Adult immunocompromised patients diagnosed with PIV lower respiratory tract infection (LRTI) who required oxygen supplementation were randomized 2:1 to nebulized DAS181 (4.5 mg/day) or matching placebo for up to 10 days. Randomization was stratified by need for mechanical ventilation (MV) or supplemental oxygen (SO). The primary endpoint was the proportion of patients reaching clinical stability survival (CSS) defined as returning to room air (RTRA), normalization of vital signs for at least 24 hours, and survival up to day 45 from enrollment. RESULTS A total of 111 patients were randomized to DAS181 (n = 74) or placebo (n = 37). CSS was achieved by 45.0% DAS181-treated patients in the SO stratum compared with 31.0% for placebo (P = .15), whereas patients on MV had no benefit from DAS181. The proportion of patients achieving RTRA was numerically higher for SO stratum DAS181 patients (51.7%) compared with placebo (34.5%) at day 28 (P = .17). In a post hoc analysis of solid organ transplant, hematopoietic cell transplantation within 1 year, or chemotherapy within 1 year, more SO stratum patients achieved RTRA on DAS181 (51.8%) compared with placebo (15.8%) by day 28 (P = .012). CONCLUSIONS The primary endpoint was not met, but post hoc analysis of the RTRA component suggests DAS181 may have clinical activity in improving oxygenation in select severely immunocompromised patients with PIV LRTI who are not on mechanical ventilation. Clinical Trials Registration. NCT01644877.
Collapse
Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Francisco M Marty
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Steven J Lawrence
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sanjeet Dadwal
- Department of Infectious Disease, City of Hope, Duarte, California, USA
| | - Rosemary Soave
- New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | | - Michael Boeckh
- Vaccine and Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| |
Collapse
|
16
|
National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2020 Highly morbid forms report. Transplant Cell Ther 2021; 27:817-835. [PMID: 34217703 DOI: 10.1016/j.jtct.2021.06.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/12/2022]
Abstract
Chronic graft-versus-host disease (GVHD) can be associated with significant morbidity, in part because of nonreversible fibrosis, which impacts physical functioning (eye, skin, lung manifestations) and mortality (lung, gastrointestinal manifestations). Progress in preventing severe morbidity and mortality associated with chronic GVHD is limited by a complex and incompletely understood disease biology and a lack of prognostic biomarkers. Likewise, treatment advances for highly morbid manifestations remain hindered by the absence of effective organ-specific approaches targeting "irreversible" fibrotic sequelae and difficulties in conducting clinical trials in a heterogeneous disease with small patient numbers. The purpose of this document is to identify current gaps, to outline a roadmap of research goals for highly morbid forms of chronic GVHD including advanced skin sclerosis, fasciitis, lung, ocular and gastrointestinal involvement, and to propose strategies for effective trial design. The working group made the following recommendations: (1) Phenotype chronic GVHD clinically and biologically in future cohorts, to describe the incidence, prognostic factors, mechanisms of organ damage, and clinical evolution of highly morbid conditions including long-term effects in children; (2) Conduct longitudinal multicenter studies with common definitions and research sample collections; (3) Develop new approaches for early identification and treatment of highly morbid forms of chronic GVHD, especially biologically targeted treatments, with a special focus on fibrotic changes; and (4) Establish primary endpoints for clinical trials addressing each highly morbid manifestation in relationship to the time point of intervention (early versus late). Alternative endpoints, such as lack of progression and improvement in physical functioning or quality of life, may be suitable for clinical trials in patients with highly morbid manifestations. Finally, new approaches for objective response assessment and exploration of novel trial designs for small populations are required.
Collapse
|
17
|
Challenges of Cellular Therapy During the COVID-19 Pandemic. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:657-672. [PMID: 33973204 DOI: 10.1007/978-3-030-63761-3_36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Currently, coronavirus disease 2019 (COVID-19) has spread worldwide and continues to rise. There remains a significant unmet need for patients with hematological malignancies requiring specialized procedures and treatments, like cellular therapy to treat or cure their disease. For instance, chimeric antigen receptor T (CAR-T) cell therapy is approved for relapsed/refractory (after two or more lines of therapy) diffuse large B cell lymphoma and B cell acute lymphoblastic leukemia that is refractory or in the second relapse in patients younger than 25 years of age. Similarly, hematopoietic stem cell transplantation (HSCT) can be a lifesaving procedure for many patients, such as those with acute myeloid leukemia with high-risk cytogenetics. Unfortunately, the COVID-19 pandemic has thrust upon the hematologists and transplant specialists' unique challenges with the implementation and management of cellular therapy. One of the significant concerns regarding this immunocompromised patient population is the significant risk of acquiring SARS-CoV-2 infection due to its highly contagious nature. Experts have recommended that if medically indicated, especially in high-risk disease (where chemotherapy is unlikely to work), these lifesaving procedures should not be delayed even during the COVID-19 pandemic. However, proceeding with CAR-T cell therapy and HSCT during the pandemic is a considerable task and requires dedication from the transplant team and buy-in from the patients and their family or support system. Open conversations should be held with the patients about the risks involved in undergoing cellular therapies during current times and the associated future uncertainties.
Collapse
|
18
|
Kitko CL, Pidala J, Schoemans HM, Lawitschka A, Flowers ME, Cowen EW, Tkaczyk E, Farhadfar N, Jain S, Steven P, Luo ZK, Ogawa Y, Stern M, Yanik GA, Cuvelier GDE, Cheng GS, Holtan SG, Schultz KR, Martin PJ, Lee SJ, Pavletic SZ, Wolff D, Paczesny S, Blazar BR, Sarantopoulos S, Socie G, Greinix H, Cutler C. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IIa. The 2020 Clinical Implementation and Early Diagnosis Working Group Report. Transplant Cell Ther 2021; 27:545-557. [PMID: 33839317 PMCID: PMC8803210 DOI: 10.1016/j.jtct.2021.03.033] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
Recognition of the earliest signs and symptoms of chronic graft-versus-host disease (GVHD) that lead to severe manifestations remains a challenge. The standardization provided by the National Institutes of Health (NIH) 2005 and 2014 consensus projects has helped improve diagnostic accuracy and severity scoring for clinical trials, but utilization of these tools in routine clinical practice is variable. Additionally, when patients meet the NIH diagnostic criteria, many already have significant morbidity and possibly irreversible organ damage. The goals of this early diagnosis project are 2-fold. First, we provide consensus recommendations regarding implementation of the current NIH diagnostic guidelines into routine transplant care, outside of clinical trials, aiming to enhance early clinical recognition of chronic GVHD. Second, we propose directions for future research efforts to enable discovery of new, early laboratory as well as clinical indicators of chronic GVHD, both globally and for highly morbid organ-specific manifestations. Identification of early features of chronic GVHD that have high positive predictive value for progression to more severe manifestations of the disease could potentially allow for future pre-emptive clinical trials.
Collapse
Affiliation(s)
- Carrie L Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Joseph Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Hélène M Schoemans
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Anita Lawitschka
- St. Anna Children's Hospital, Children's Cancer Research Institute, Vienna, Austria
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Eric Tkaczyk
- Research & Dermatology Services, Department of Veterans Affairs, Nashville, Tennessee; Vanderbilt Dermatology Translational Research Clinic, Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Sandeep Jain
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois
| | - Philipp Steven
- Division for Dry-Eye Disease and Ocular GVHD, Department of Ophthalmology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Zhonghui K Luo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Michael Stern
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois; ImmunEyez LLC, Irvine, California
| | - Greg A Yanik
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Geoffrey D E Cuvelier
- Pediatric Blood and Marrow Transplantation, Department of Pediatric Oncology-Hematology-BMT, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Shernan G Holtan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kirk R Schultz
- Pediatric Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Steven Z Pavletic
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce R Blazar
- Department of Pediatrics, Division of Blood & Marrow Transplantation & Cellular Therapy, University of Minnesota, Minneapolis, Minnesota
| | - Stephanie Sarantopoulos
- Division of Hematological Malignancies and Cellular Therapy, Duke University Department of Medicine, Duke Cancer Institute, Durham, North Carolina
| | - Gerard Socie
- Hematology Transplantation, AP-HP Saint Louis Hospital & University of Paris, INSERM U976, Paris, France
| | - Hildegard Greinix
- Clinical Division of Hematology, Medical University of Graz, Graz, Austria
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
19
|
Xhaard A, Xhaard C, D’Aveni M, Salvator H, Chabi M, Berceanu A, Coman T, Beguin Y, Chalandon Y, Poiré X, Loschi M, Paillard C, Bruno B, Ceballos P, Dalle J, Bilger K, Bay J, Robin M, N’Guyen‐Quoc S, Rubio M. Risk factors for a severe form of COVID-19 after allogeneic haematopoietic stem cell transplantation: a Société Francophone de Greffe de Moelle et de Thérapie cellulaire (SFGM-TC) multicentre cohort study. Br J Haematol 2021; 192:e121-e124. [PMID: 33522598 PMCID: PMC8013848 DOI: 10.1111/bjh.17260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alienor Xhaard
- Service d’Hématologie‐GreffeHôpital Saint‐LouisUniversité Paris DiderotParisFrance
| | - Constance Xhaard
- Centre d’Investigations Cliniques Plurithématique 1433Université de LorraineINSERMINSERM 1116CHRU de NancyFCRIN INI‐CRCTNancyFrance
| | - Maud D’Aveni
- Service d’HématologieHôpital BraboisCHRU Nancy et CNRS UMR 7563Biopôle de l’Université de LorraineVandoeuvre les NancyFrance
| | | | | | - Ana Berceanu
- Service d’HematologieCHU Jean MinjozBesançonFrance
| | - Tereza Coman
- Service d’HématologieInstitut Gustave RoussyVillejuifFrance
| | - Yves Beguin
- Department of HaematologyCHU of LiègeUniversity of LiègeLiègeBelgium
| | - Yves Chalandon
- Service d’HématologieFaculty of MedicineHôpitaux Universitaires de GenèveUniversity of GenevaGenèveSuisse
| | | | | | | | | | | | | | - Karin Bilger
- Service d’HématologieCHRU StrasbourgStrasbourgFrance
| | | | - Marie Robin
- Service d’Hématologie‐GreffeHôpital Saint‐LouisUniversité Paris DiderotParisFrance
| | | | - Marie‐Therese Rubio
- Service d’HématologieHôpital BraboisCHRU Nancy et CNRS UMR 7563Biopôle de l’Université de LorraineVandoeuvre les NancyFrance
| |
Collapse
|
20
|
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. Bone Marrow Transplant 2019; 55:431-440. [PMID: 31551521 PMCID: PMC7091566 DOI: 10.1038/s41409-019-0698-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 11/08/2022]
Abstract
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.
Collapse
|