Morbidity and Mortality Associated With Respiratory Virus Infections in Allogeneic Hematopoietic Cell Transplant: Too Little Defense or Harmful Immunity?

Abstract

The impact on morbidity and mortality of Community Acquired Respiratory Virus (CARV) infections in patients undergoing Allogeneic Hematopoietic Cell Transplant (HCT) is widely studied. Here we give an overview of the current literature on the incidence and chance of progression to severe disease in this highly immune compromised population. We discuss the issue whether it is predominantly direct viral damage that causes clinical deterioration, or that it is in fact the allogeneic immuneresponse to the virus that is most important. This is an important question as it will guide therapeutic decision making. It asks for further collaborative studies focusing on sensitive surveillance with PCR techniques and relating clinical data with parameters of immune reconstitution.

Keywords: allogeneic transplant of hematopoietic stem cells; alloimmunity and transplantation; lung disease; outcome; respiratory virus infection.

Figure 1

Incidence of common respiratory viral infections (CRV) and associated progression to Lower Respiratory Tract Infections (LRTI) and mortality in HCT recipients. Updated from Shah et al. (2012), based on (Versluys et al., ; Shah et al., ; Chemaly et al., ; Campbell et al., ; Robinson et al., ; Fisher et al., ; Green, 2017).