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Significant Transplant-Related Mortality from Respiratory Virus Infections within the First 100 Days Post Hematopoietic Stem Cell Transplantation

Track: Poster Abstracts
Wednesday, February 26, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Sakara Hutspardol, MD , Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
Tal Schechter-Finkelstein, MD , Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
Muhammad Ali, MD , Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
Joerg Krueger, MD , Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
R. Maarten Egeler, MD, PhD , Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
Upton Allen, MBBS, MSc, FAAP, FRCPC , Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
Susan Richardson, MD, FRCP(C) , Laboratory Medicine and Pathology, Hospital for Sick Children, Toronto, ON, Canada
Adam Gassas, MD, MBChB, MSc, MRCP, DCH , Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
Respiratory virus infections are recognized as an important complication in hematopoietic stem cell transplantation (HSCT). Respiratory syncytial virus (RSV), influenza, and parainfluenza have been associated with high morbidity and mortality post HSCT. Despite an increasing number of reports, knowledge regarding risk factors and long term pulmonary complications are still very limited. Therefore, we report our study to evaluate incidence and outcome of respiratory virus infections following HSCT in a large pediatric transplant centre.

Eight hundred and forty four children received HSCT during the study period (January 2000 and August 2012). The number of patients undergoing allogeneic (allo) transplant was 489 and autologous (auto) was 355.  Thirty-five patients (4.2%) were found to have respiratory virus infection diagnosed by a nasopharyngeal aspirate (NPA) in the first 100 days post HSCT. Among these, 22 (63%) and 13 (37%) were allo and auto HSCT recipients, respectively. Upper and lower respiratory tract infection were documented in 19 (54.3%) and 16 (45.7%) patients, respectively. The viruses identified were parainfluenza 37%, influenza 26%, RSV 23%, adenovirus 11%, and human metapneumovirus 3%. None of the patients had significant respiratory symptoms prior to HSCT.

Seven patients died from disease relapse and were excluded from outcome analysis. Of the remaining 28 patients, five HSCT recipients (4 allo and 1 auto) have died (18%). All patients who died were in the lower respiratory tract infection group and their death was directly attributed to pulmonary complications as a result of respiratory virus infections. Two patients died from adenovirus pneumonitis and ARDS. Two patients died from severe parainfluenza infection with deterioration of symptoms and respiratory failure despite treatment with ribavarin and the last patient had ARDS from RSV infection. No chronic pulmonary complication or allo-immune lung syndrome was observed among the remaining 23 survivors with a median follow-up time of 3.8 years (8 months-10.3 years).

This study supports the significant TRM from respiratory virus infection diagnosed within the first 100 days post HSCT particularly in patients presented with lower respiratory tract infection. Higher mortality was observed among allo recipients. Every effort should be made to prevent respiratory virus infections early post HSCT.

Disclosures:
Nothing To Disclose
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