SARS-CoV-2; allogeneic hematopoietic stem cell transplantation; community-acquired respiratory virus; human Coronavirus; human metapneumovirus; immunocompromised; immunodeficiency score index; multiplex PCR assay; paramyxovirus; upper and lower respiratory tract disease; Infectious Diseases; Immunology and Allergy
Abstract :
[en] [en] PATIENTS AND METHODS: This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allogeneic stem cell transplantation (allo-HCT).
RESULTS: We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases.
CONCLUSIONS: These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.
Disciplines :
Pediatrics
Author, co-author :
Piñana, Jose Luis; Hematology Department, Hospital Clinico Universitario de Valencia, Spain. Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Spain
Ljungman, Per; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge and Dept. of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
Mikulska, Malgorzata; Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova Italy
Salmenniemi, Urpu; Hematology Department, HUCH Comprehensive Cancer Center, Helsinki, Finland
Perez, Ariadna; Hematology Department, Hospital Clinico Universitario de Valencia, Spain. Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Spain
Kröger, Nicolaus; Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf/Germany
Cornelissen, Jan; Hematology Department, Erasmus MC Cancer Institute, Rotterdam, Netherlands
Sala, Elisa; Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
Martino, Rodrigo; Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
Geurten, Claire ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pédiatrie
Byrne, Jenny; Hematology Department, Nottingham University, Nottingham, United Kingdom
Maertens, Johan; Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
Kerre, Tessa; Hematology Department, Ghent University Hospital, Gent, Belgium
Martin, Murray; Hematology Department, Leicester Royal Infirmary, Leicester, United Kingdom
Pascual, Maria Jesús; Hematology Department, Hospital Regional de Málaga, Malaga, Spain
Yeshurun, Moshe; Institution of Hematology, Rabin medical Center, Petach-Tikva, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Finke, Jürgen; University of Freiburg, Freiburg, Germany
Groll, Andreas H; Infectious Disease Research Program, Department of Pediatric Hemtology and Oncology and Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
Shaw, Peter J; The Children`s Hospital at Westmead, Sydney, Australia
Blijlevens, Nicole; Nijmegen Medical Centre, Nijmegen, Netherlands
Arcese, William; Tor Vergata University of Rome, Rome, Italy
Ganser, Arnold; Hannover Medical School, Hannover, Germany
Alzahrani, Mohsen; Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard - Health Affaris, Riyadh, Saudi Arabia
Choi, Goda; University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Forcade, Edouard; Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
Paviglianiti, Annalisa; Institut Català de Oncología - Hospital Duran i Reynals, Barcelona, Spain
Solano, Carlos; Hematology Department, Hospital Clinico Universitario de Valencia, Spain. Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Spain ; Department of Medicine. University of Valencia, Spain
Wachowiak, Jacek; Department of Pediatric Oncology, Hematology and HCT, University of Medical Sciences, Poznan, Poland
Zuckerman, Tsila; Rambam Medical Center, Haifa, Israel
Bader, Peter; Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Pediatrics and Adolescent Medicine, University Hospital, Goethe University, Frankfurt, Germany
Clausen, Johannes; Department of Internal Medicine I, Ordensklinikum Linz - Elisabethinen, Johannes Kepler University, Linz, Austria
Mayer, Jiri; Masaryk University Hospital Brno, Brno, Czech Rep
Schroyens, Wilfried; Antwerp University Hospital (UZA), Antwerp Edegem, Belgium
Metafuni, Elisabetta; Fondazione Policlinico Universitario Agostino Gemelli IRCCS. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e EmatologiaGemelli IRCCS, Roma, Italy
Knelange, Nina; EBMT Leiden Study Unit, Leiden, The Netherlands
Averbuch, Dina; Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
de la Camara, Rafael; Hematology Department, Hospital de la Princesa, Madrid, Spain ; Hematology Department, Hospital Universitario Sanitas La Zarzuela, Madrid, Spain
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