416 Identification of Respiratory Viral Infection in Haematopoietic Stem Cell Transplant Recipients - Impact on Non Relapse Mortality

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Louise Imlay-Gillespie , Department of Haematology, Royal North Shore Hospital, Sydney, Australia
Meera Srinivasan , Department of Haematology, Royal North Shore Hospital, Sydney, Australia
Kelly Wong , Department of Haematology, Royal North Shore Hospital, Sydney, Australia
Christopher Arthur , Department of Haematology, Royal North Shore Hospital, Sydney, Australia
Keith Fay, MD , Department of Haematology, Royal North Shore Hospital, Sydney, Australia
Ian Kerridge , University of Sydney, Sydney, Australia
William Stevenson , University of Sydney, Sydney, Australia
Matthew Greenwood , Department of Haematology, Royal North Shore Hospital, Sydney, Australia
Presentation recording not available for download or distribution as requested by the presenting author.
Aim

Infection is the leading cause of non-relapse mortality (NRM) in allo-HSCT. A community respiratory virus infection (RVI) screening program was instituted at our centre from 5/2010 in order to prevent nosocomial infection, assist in cohorting strategies and minimise RV during allo-HSCT. The impact of RVI screening on respiratory-related NRM was assessed.

Method

Consecutive allo-HSCT patients (pts) experiencing NRM between 1/00 – 1/14 were identified from a prospectively maintained database.  NRM episodes were assessed pre- and post-RVI screening and an etiology assigned following medical record review and treating physician determination. RVI were identified in symptomatic pts from nasal/pharyngeal swabs or bronchoalveloar lavage specimens using PCR or immunofluorescence.

Results

204 allo-HSCT were evaluated, 118 pre- and 86 post-RVI screening. For the entire cohort: male:female ratio was 1.4:1,  median age 52 (17-71) years , median follow up 24.2 (2.4-154) months. Most common pre-HSCT diagnoses were myeloid malignancies (43%), NHL (22%) ALL (12%). 3 year DFS and OS was 50.7% and 59.6%. There were no significant differences between study cohorts. There was a significant difference between pre-RV and post-RV cohorts in conditioning intensity (MA 46% vs 19%, NMA 53% vs 81%, p<0.01), donor source (MS 71% vs 29%, MUD 0 vs 44%, p<0.01) and TBI-based conditioning (20% vs 51%, p<0.01) reflecting changes in departmental practice.   Most common RVI’s were rhinovirus (40%), RSV (30%), parainfluenza (20%) and coronavirus (10%).

Overall NRM was 24.5%.Pre- and post-RVI screening NRM was 22.9% and 26.7% (p=0.53). 12/26 (46%) NRM events were respiratory-related pre-RVI  vs 6/24 (25%) post-RVI (RR 0.54, 95%CI 0.24-1.22, p=0.14). Post-RVI screening, viral pneumonitis was the cause of respiratory death in 2/5 pts (1=RSV, 1=rhinovirus).

Conclusion

Respiratory-related deaths represent a significant NRM  burden post allo-HSCT. RVI screening may impact on respiratory-related NRM in allo-HSCT.

Disclosures:
Nothing To Disclose
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