Respiratory virus infection before HCT increases mortality
Routine testing for respiratory viruses before hematopoietic cell transplantation is reasonable in symptomatic patients and transplantation should be delayed when possible, according to recent data.
“Current clinical practice guidelines regarding timing of transplantation if respiratory viruses are present are largely based on expert opinion,” the researchers wrote in Clinical Infectious Diseases. “Our study provides evidence that current recommendations regarding delaying transplantation for symptomatic respiratory infections are justified.”
Between December 2005 and February 2010, Angela P. Campbell, MD, MPH, of the CDC, and colleagues collected nasal washes from 458 patients before and through day 100 after hematopoietic cell transplantation (HCT). The researchers used multiplex PCR to test for: respiratory syncytial virus, parainfluenza virus 1-4, influenza A and B, human metapneumovirus, adenovirus, human rhinoviruses, coronaviruses and bocavirus.
Testing revealed that 116 patients had respiratory viruses before HCT. Bronchoscopy incidence was similar for patients with and without respiratory viruses (adjusted HR = 1.3; 95% CI, 0.8-2).
On average, the patients diagnosed with respiratory viruses before HCT spent 8 fewer days alive and out of the hospital than those with no respiratory viruses before HCT. Overall mortality at day 100 was higher in patients with pre-HCT respiratory viruses (aHR = 2.4; 95% CI, 1.3-4.5).
Although the risk for death in patients with influenza or RSV was no different between groups, patients with rhinovirus detected pre-HCT had a significantly greater risk for death at day 100 (aHR = 2.6; 95% CI, 1.2-5.5). The researchers said this may be a result of most patients with RSV and influenza receiving either antiviral treatment or undergoing delayed HCT.
In addition, overall mortality was greater in symptomatic patients whose viruses were detected before HCT (unadjusted HR = 3.4; 95% CI, 1-11.8).
“Because effective treatment is unavailable for many respiratory viruses and delay of HCT is often not feasible, these data emphasize the need for intensified prevention of respiratory virus acquisition before transplantation and improved management strategies, including development of new antiviral agents and other prophylactic strategies,” the researchers wrote. – by Colleen Owens
Disclosure: Campbell reports receiving funding from the NIH and the Seattle Children’s Center for Clinical and Translational Research. Please see the full study for a list of all other authors’ relevant financial disclosures.