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Review
. 2020 Apr;33(2):205-213.
doi: 10.1097/QCO.0000000000000626.

Pulmonary infections in the hematopoietic cell transplant patient

Emily S Ford  1   2 , Kristina Crothers  3   4 , Guang-Shing Cheng  4   5
Affiliations
Review

Pulmonary infections in the hematopoietic cell transplant patient

Emily S Ford et al. Curr Opin Infect Dis. 2020 Apr.

Abstract

Purpose of review: Despite progress in the management of pulmonary infections in the hematopoietic cell transplant (HCT) population, substantial diagnostic, and therapeutic uncertainty remains.

Recent findings: A growing HCT population reflects more transplants and improved long-term survival. We continue to learn about the epidemiologic and prognostic significance of posttransplant pulmonary infections. Mold-active triazoles have removed invasive fungal pneumonia as a barrier to transplant eligibility. Ibrutinib and respiratory viruses are newly recognized risk factors for invasive fungal disease. Prophylaxis has elevated concerns of resistance in invasive fungal species and late onset Cytomegalovirus. The impact of human herpesviruses, community-associated respiratory viruses, and the microbiome is increasingly appreciated. Multiple antiviral therapies are currently in clinical trials and novel molecular diagnostics may improve the performance of bronchoscopy for infectious causes.

Summary: Fungal and viral pneumonias remain an important cause of morbidity and mortality in the HCT population. Despite our increased understanding of the epidemiology and outcomes of species-specific diagnoses, the utility of invasive diagnostic testing continues to be debated and effective therapies for many clinically relevant pathogens remain limited. Pulmonary infections are a priority for research efforts in this immunocompromised population.

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References

    1. McDonald GB, Sandmaier BM, Mielcarek M, et al. Survival, nonrelapse mortality, and relapse-related mortality after allogeneic hematopoietic cell transplantation: Comparing 2003–2007 vs. 2013–2017 cohorts. Ann Intern Med 2020; 172: in press.
    1. D'Souza A, Fretham C. Current uses and outcomes of hematopoietic cell transplantation (HCT): CIBMTR summary slides. 2018; Available at https://www.cibmtr.org, 1 November 2019.
    1. Valentine JC, Morrissey CO, Tacey MA, et al. A population-based analysis of invasive fungal disease in haematology–oncology patients using data linkage of state-wide registries and administrative databases: 2005–2016. BMC Infect Dis 2019; 19:274.
    1. Erard V, Guthrie KA, Seo S, et al. Reduced mortality of cytomegalovirus pneumonia after hematopoietic cell transplantation due to antiviral therapy and changes in transplantation practices. Clin Infect Dis 2015; 61:31–39.
    1. Arendrup MC, Jensen RH, Meletiadis J. In vitro activity of isavuconazole and comparators against clinical isolates of the Mucorales order. Antimicrob Agents Chemother 2015; 59:7735–7742.

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