José Luis Piñana, Clara Martínez-López, Pedro Chorão, Ariadna Pérez, Dolores Gómez, Jaime Sanz, Carlos Solano de la Asunción, Juan Carlos Hernández-Boluda, David Navarro, Juan Montoro, Carlos Solano
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引用次数: 0
Abstract
Background: Community-acquired respiratory virus (CARV) infections are frequent and potentially severe in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. However, their impact during the peri-engraftment period remains underexplored.
Methods: In this retrospective multicenter study, we assessed the characteristics, effects on neutrophil engraftment, and risk factors for lower respiratory tract disease (LRTD) progression and 100-day mortality of symptomatic peri-engraftment CARV infections [from Day -8 until Day +36 after stem cell infusion]. A total of 112 allo-HCT recipients and 114 CARV episodes were included. Univariable and multivariable Cox regression analyses and cumulative incidence estimates were used.
Results: The median patient age was 51 years. Rhinovirus (47%) and respiratory syncytial virus (23%) were the most common pathogens. Half of the infections occurred before neutrophil engraftment (median day +18), and 50% progressed to LRTD. The 100-day mortality rate was 17%, increasing to 27% in those with LRTD. CARV infection prior to engraftment was associated with delayed neutrophil recovery (Day +18 vs. +16; p = 0.04) in multivariable cause-specific Cox regression analysis (HR 0.42, p < 0.001). Multivariable analysis identified lymphocyte count <0.2×10⁹/L (HR 3.1, p = 0.004) and active graft-versus-host disease (HR 2.36, p = 0.004) as independent predictors of LRTD. Risk factors for 100-day mortality included LRTD (HR 3.34, p = 0.04), use of anti-thymocyte globulin (HR 3.48, p = 0.019), and bacterial coinfection (HR 4.48, p = 0.006).
Conclusion: CARV infections during the peri-engraftment allo-HCT phase carry a high risk for delayed engraftment and LRTD in case of profound lymphopenia and GvHD. LRTD, ATG use, and bacterial coinfections contributed significantly to mortality.
期刊介绍:
Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal.
Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.