Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA.
Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea.
Blood Adv. 2022 Sep 27;6(18):5307-5316. doi: 10.1182/bloodadvances.2021004915.
Pretransplant respiratory virus infections (RVIs) have been shown to negatively affect hematopoietic cell transplantation (HCT) outcomes. The impact of and need for delay of HCT for pretransplant infection with human rhinovirus (HRV) or endemic human coronavirus (HCoV; 229E, OC43, NL63, and HKU1) remain controversial. We analyzed the impact of symptomatic RVI within ≤90 days before HCT on overall mortality, posttransplant lower respiratory tract disease (LRD), and days alive and out of hospital (DAOH) by day 100 post-HCT in multivariable models. Among 1,643 adult HCT recipients (58% allogeneic recipients), 704 (43%) were tested for RVI before HCT, and 307 (44%) tested positive. HRV was most commonly detected (56%). Forty-five (15%) of 307 HCT recipients had LRD with the same virus early after HCT. Pretransplant upper respiratory tract infection (URI) with influenza, respiratory syncytial virus, adenovirus, human metapneumovirus, parainfluenza virus, HRV, or endemic HCoV was not associated with increased overall mortality or fewer DAOH. However, in allogeneic recipients who received myeloablative conditioning, LRD due to any respiratory virus, including HRV alone, was associated with increased overall mortality (adjusted hazard ratio, 10.8 [95% confidence interval, 3.29-35.1] for HRV and 3.21 [95% confidence interval, 1.15-9.01] for all other viruses). HRV LRD was also associated with fewer DAOH. Thus, the presence of LRD due to common respiratory viruses, including HRV, before myeloablative allogeneic HCT was associated with increased mortality and hospitalization. Pretransplant URI due to HRV and endemic HCoV was not associated with these outcomes. Improved management strategies for pretransplant LRD are warranted.
移植前呼吸道病毒感染（RVI）已被证明会对造血细胞移植（HCT）的结果产生负面影响。对于人鼻病毒（HRV）或地方性人类冠状病毒（229E、OC43、NL63 和 HKU1）移植前感染是否需要延迟 HCT 存在争议。我们在多变量模型中分析了 HCT 前≤90 天内有症状的 RVI 对总死亡率、移植后下呼吸道疾病（LRD）以及 HCT 后第 100 天前的存活和出院天数（DAOH）的影响。在 1643 名成年 HCT 受者（58%为异基因受者）中，有 704 名（43%）在 HCT 前接受了 RVI 检测，其中 307 名（44%）检测呈阳性。最常检测到 HRV（56%）。45 名（15%）接受 HCT 的 307 名受者在 HCT 后早期出现同种异体 LRD。移植前上呼吸道感染（URI）与流感、呼吸道合胞病毒、腺病毒、人偏肺病毒、副流感病毒、HRV 或地方性 HCoV 与总死亡率增加或 DAOH 减少无关。然而，在接受清髓性调理的异基因受者中，任何呼吸道病毒引起的 LRD，包括单独的 HRV，与总死亡率增加相关（调整后的危险比，HRV 为 10.8[95%置信区间，3.29-35.1]，所有其他病毒为 3.21[95%置信区间，1.15-9.01]）。HRV LRD 也与 DAOH 减少有关。因此，在清髓性异基因 HCT 前存在常见呼吸道病毒（包括 HRV）引起的 LRD 与死亡率和住院率增加有关。HRV 和地方性 HCoV 引起的移植前 URI 与这些结果无关。需要制定更好的移植前 LRD 管理策略。
