Clinical outcomes associated with respiratory virus detection before allogeneic hematopoietic stem cell transplant

Abstract

Background: The management of respiratory virus infections prior to hematopoietic cell transplant (HCT) is difficult. We examined whether respiratory virus detection before HCT influenced the requirement for bronchoscopy, hospitalization, and overall survival following HCT.

Methods: Pre-HCT and weekly post-HCT nasal washes were collected through day 100 from patients with and without symptoms. Samples were tested by multiplex polymerase chain reaction for respiratory syncytial virus, parainfluenza viruses 1-4, influenza A and B, human metapneumovirus, adenovirus, and human rhinoviruses, coronaviruses, and bocavirus.

Results: Of 458 patients, 116 (25%) had respiratory viruses detected pre-HCT. Overall, patients with viruses detected pre-HCT had fewer days alive and out of the hospital and lower survival at day 100 (adjusted hazard ratio [aHR], 2.4; 95% confidence interval [CI], 1.3-4.5; P = .007) than patients with negative samples; this risk was also present with rhinovirus alone (aHR for mortality, 2.6; 95% CI, 1.2-5.5; P = .01). No difference in bronchoscopy incidence was seen in patients with and without respiratory viruses (aHR, 1.3; 95% CI, .8-2.0; P = .32). In symptomatic patients, those with respiratory viruses detected had increased overall mortality compared with patients without viruses detected (unadjusted HR, 3.5; 95% CI, 1.0-12.1; P = .05); among asymptomatic patients, detection of respiratory viruses was not associated with increased mortality.

Conclusions: These data support routine testing for respiratory viruses among symptomatic patients before HCT, and delay of transplant with virus detection when feasible, even for detection of rhinovirus alone. Further study is needed to address whether asymptomatic patients should undergo screening for respiratory virus detection before HCT.

Keywords: hematopoietic cell transplant; pneumonia; respiratory virus infection.

Figure 1.

Pretransplant respiratory virus samples collected in the presence of clinical symptoms (symptomatic) and for surveillance alone (surveillance). The diagram shows number of patients with samples collected for clinical care and/or for the prospective research study. Clinical care samples include samples from symptomatic patients, surveillance samples collected during a respiratory syncytial virus outbreak, and surveillance samples collected from children. Patients with these surveillance samples combined with the patients who provided research samples alone comprised the asymptomatic surveillance cohort.

Figure 2.

A, Probability of at least 1 bronchoscopy by pretransplant respiratory viral status (P = .10). B, Probability of at least 1 bronchoscopy by pretransplant respiratory viral status, by virus group. Group 1 includes respiratory syncytial virus, human metapneumovirus, parainfluenza virus, influenza A and B, and adenovirus (P = .03); group 2 includes human rhinovirus, human coronavirus, and human bocavirus (P = .54).

Figure 3.

A, Days alive and out of hospital within the first 100 days after hematopoietic cell transplant (HCT) by pretransplant respiratory viral status (P = .001). B, Days alive and out of hospital within the first 100 days after HCT by pretransplant respiratory viral status, by virus group. Group 1 includes respiratory syncytial virus, human metapneumovirus, parainfluenza virus, influenza A and B, and adenovirus (P = .03); group 2 includes human rhinovirus, human coronavirus, and human bocavirus (P = .007). Boxes represent the 25th, 50th, and 75th percentiles, and whiskers show the 10th and 90th percentiles.

Figure 4.

A, Overall mortality by pretransplant respiratory viral status (P = .02). B, Overall mortality by pretransplant respiratory viral status, by virus group. Group 1 includes respiratory syncytial virus, human metapneumovirus, parainfluenza virus, influenza A and B, and adenovirus (P = .08); group 2 includes human rhinovirus, human coronavirus, and human bocavirus (P = .05).