Respiratory viruses in hematopoietic cell transplant candidates: impact of preexisting lower tract disease on outcomes

Abstract

Pretransplant respiratory virus infections (RVIs) have been shown to negatively affect hematopoietic cell transplantation (HCT) outcomes. The impact of and need for delay of HCT for pretransplant infection with human rhinovirus (HRV) or endemic human coronavirus (HCoV; 229E, OC43, NL63, and HKU1) remain controversial. We analyzed the impact of symptomatic RVI within ≤90 days before HCT on overall mortality, posttransplant lower respiratory tract disease (LRD), and days alive and out of hospital (DAOH) by day 100 post-HCT in multivariable models. Among 1,643 adult HCT recipients (58% allogeneic recipients), 704 (43%) were tested for RVI before HCT, and 307 (44%) tested positive. HRV was most commonly detected (56%). Forty-five (15%) of 307 HCT recipients had LRD with the same virus early after HCT. Pretransplant upper respiratory tract infection (URI) with influenza, respiratory syncytial virus, adenovirus, human metapneumovirus, parainfluenza virus, HRV, or endemic HCoV was not associated with increased overall mortality or fewer DAOH. However, in allogeneic recipients who received myeloablative conditioning, LRD due to any respiratory virus, including HRV alone, was associated with increased overall mortality (adjusted hazard ratio, 10.8 [95% confidence interval, 3.29-35.1] for HRV and 3.21 [95% confidence interval, 1.15-9.01] for all other viruses). HRV LRD was also associated with fewer DAOH. Thus, the presence of LRD due to common respiratory viruses, including HRV, before myeloablative allogeneic HCT was associated with increased mortality and hospitalization. Pretransplant URI due to HRV and endemic HCoV was not associated with these outcomes. Improved management strategies for pretransplant LRD are warranted.

Graphical abstract

Figure 1.

Overall mortality by day 100 in allogeneic recipients. Forest plots based on multivariable Cox regression for overall mortality by day 100 in all allogeneic recipients (A, n = 946) and in allogeneic recipients receiving myeloablative conditioning (B, n = 671). HRV, human rhinovirus; HCT-CI, hematopoietic cell transplantation comorbidity index; LRD, lower respiratory tract disease.

Figure 2.

Days alive and out of hospital (DAOH) in allogeneic recipients. Forest plot based on multivariable linear regression for DAOH in all allogeneic recipients (A), in myeloablative allogeneic recipients (B), and in allogeneic recipients receiving non-myeloablative conditioning (C, n = 275). HRV, human rhinovirus; HCT-CI, hematopoietic cell transplantation comorbidity index; LRD, lower respiratory tract disease.