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Incidence and impact of community respiratory viral infections in post-transplant cyclophosphamide-based graft-versus-host disease prophylaxis and haploidentical stem cell transplantation. Br J Haematol 2021 07;194(1):145-157

Date

06/15/2021

Pubmed ID

34124796

DOI

10.1111/bjh.17563

Scopus ID

2-s2.0-85107820824   1 Citation

Abstract

Community respiratory viral infections (CRVIs) are associated with pulmonary function impairment, alloimmune lung syndromes and inferior survival in human leucocyte antigen (HLA)-matched allogeneic haematopoietic stem cell transplant (HCT) recipients. Although the incidence of viral infections in HLA-haploidentical HCT recipients who receive post-transplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis is reportedly increased, there are insufficient data describing the incidence of CRVIs and the impact of donor source and PTCy on transplant outcomes. Analysing patients receiving their first HCT between 2012 and 2017 for acute myeloid leukaemia, acute lymphoblastic leukaemia and myelodysplastic syndromes, we describe comparative outcomes between matched sibling transplants receiving either calcineurin-based GVHD prophylaxis (SibCNI, N = 1605) or PTCy (SibCy, N = 403), and related haploidentical transplants receiving PTCy (HaploCy, N = 757). The incidence of CRVIs was higher for patients receiving PTCy, regardless of donor type. Patients in the HaploCy cohort who developed a CRVI by day +180 had both a higher risk of treatment-related mortality [hazard ratio (HR) 2⋅14, 99% confidence interval (CI) 1⋅13-4⋅07; P = 0⋅002] and inferior 2-year overall survival (HR 1⋅65, 99% CI 1⋅11-2⋅43; P = 0⋅001) compared to SibCNI with no CRVI. This finding justifies further research into long-term antiviral immune recovery, as well as development of preventive and treatment strategies to improve long-term outcomes in such patients.

Author List

Mulroney CM, Abid MB, Bashey A, Chemaly RF, Ciurea SO, Chen M, Dandoy CE, Diaz Perez MA, Friend BD, Fuchs E, Ganguly S, Goldsmith SR, Kanakry CG, Kim S, Komanduri KV, Krem MM, Lazarus HM, Ljungman P, Maziarz R, Nishihori T, Patel SS, Perales MA, Romee R, Singh AK, Reid Wingard J, Yared J, Riches M, Taplitz R

Authors

Muhammad Bilal Abid MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Soyoung Kim PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Community-Acquired Infections
Cyclophosphamide
Female
Graft vs Host Disease
HLA Antigens
Hematopoietic Stem Cell Transplantation
Humans
Immunosuppressive Agents
Incidence
Kaplan-Meier Estimate
Leukemia
Living Donors
Male
Middle Aged
Myelodysplastic Syndromes
Proportional Hazards Models
Respiratory Tract Infections
Retrospective Studies
Siblings
Transplantation, Haploidentical
Virus Diseases
Young Adult