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Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease

Bone Marrow Transplantation (2024)Cite this article

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Abstract

In the general population, influenza virus, respiratory syncytial virus, and SARS-CoV-2 are considered the most severe community-acquired respiratory viruses (CARVs). However, allogeneic stem cell transplant (allo-SCT) recipients may also face severe courses from other CARVs. This retrospective study compared outcomes of various CARV lower respiratory tract diseases (LRTD) in 235 adult allo-SCT recipients, excluding co-infection episodes. We included 235 adults allo-SCT recipients experiencing 353 CARV LRTD consecutive episodes (130 rhinovirus, 63 respiratory syncytial virus, 43 influenza, 43 human parainfluenza virus, 23 human metapneumovirus, 19 Omicron SARS-CoV-2, 17 common coronavirus, 10 adenovirus and 5 human bocavirus) between December 2013 and June 2023. Day 100 overall survival ranged from 78% to 90% without significant differences among CARV types. Multivariable analysis of day 100 all-cause mortality identified corticosteroid use of >1 to <30 mg/d [Hazard ratio (HR) 2.45, p = 0.02) and ≥30 mg/d (HR 2.20, p = 0.015) along with absolute lymphocyte count <0.2 × 109/L (HR 5.82, p < 0.001) and number of CARV episodes as a continuous variable per one episode increase (HR 0.48, p = 0.001) as independent risk factors for all-cause mortality. Degree of immunosuppression, rather than intrinsic CARV virulence, has the most significant impact on mortality in allo-SCT recipients with CARV-LRTD.

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Fig. 1: Overall survival according to CARV type.

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Data available upon formal request by email to JLP.

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Author information

Authors and Affiliations

  1. Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain

    Ariadna Pérez, Rafael Hernani, Juan Carlos Hernández-Boluda, Carlos Solano & José Luis Piñana

  2. Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    Dolores Gómez

  3. Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    Juan Montoro, Pedro Chorão, Manuel Guerreiro & Marta Villalba

  4. Microbiology Service, Hospital Clínico Universitario, Valencia, Spain

    Eliseo Albert & David Navarro

  5. Biostatistics Unit, INCLIVA, Valencia, Spain

    Juan Antonio Carbonell-Asins

  6. Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain

    Juan Carlos Hernández-Boluda & Carlos Solano

  7. Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain

    David Navarro

Authors
  1. Ariadna Pérez
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Contributions

Authors responsible for study conception and design: Jose Luis Piñana and Ariadna Perez. Authors who performed the data analysis and generated the tables and figures: Jose Luis Piñana. Authors responsible for patient recruitment: José Luis Piñana, Juan Montoro, Ariadna Pérez, Pedro Chorão, Dolores Gómez, Manuel Guerreiro, Marta Villalba, and Rafael Hernani. Authors responsible for writing the manuscript: Jose Luis Piñana, Ariadna Perez, David Navarro, Dolores Gomez, Eliseo Albert, and Carlos Solano were responsible for writing and supervising the writing of the manuscript. All co-authors were responsible for reviewing the analysis interpretation, suggesting modifications to the text, critically reviewing the manuscript, and for the final approval of the manuscript.

Corresponding author

Correspondence to José Luis Piñana.

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Competing interests

The author(s) declare that they have no conflicts of interest and have no funding resources to declare for this study.

Ethics approval

The local research ethics committee of the Hospital Clínico Universitario of Valencia approved the registry and study protocol (reference code 2019/351).

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All patients included in this registry gave their signed informed consent in accordance with the declaration of Helsinki.

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Pérez, A., Gómez, D., Montoro, J. et al. Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02304-4

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