Abstract:These data support routine testing for respiratory viruses among symptomatic patients before HCT, and delay of transplant with virus detection when feasible, even for detection of rhinovirus alone. Further study is needed to address whether asymptomatic patients should undergo screening for respiratory virus detection before HCT.
“…Notably, most of these patients were asymptomatic and only had abnormal pulmonary function testing prior to transplant without signs of active infection. However, independently, a history of infection was also associated with worse outcomes in our study, and this finding corroborates prior studies . The reason why AYAs undergoing allogeneic HSCT have such a substantial rate of reduced pulmonary function is not clear, but is likely related to adverse effects from previous chemotherapeutic agents, irradiation, or infections during prior therapy .…”
Background
Adolescents and young adults (AYAs) undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have unique risk factors and poor outcomes when compared to children, but this population has not been well studied. A hematopoietic stem cell transplantation‐comorbidity index (HCT‐CI) has been developed in adults to help predict outcomes, yet this index does not seem suitable for a younger population. Therefore, we sought to examine the prevalence of various risk factors in AYAs undergoing allogeneic HSCT and determine which factors had the greatest impact on overall survival (OS) and treatment‐related mortality (TRM).
Procedures
This was accomplished by retrospectively collecting data on 241 patients who received their first allogeneic HSCT at UCLA between 2005 and 2015. We investigated the effect of multiple predictors using the Cox proportional hazards model and Fine and Gray competing risk model for OS and TRM, respectively.
Results
Our results showed that AYAs undergoing allogeneic HSCT had poor outcomes, with 5‐year OS and NRM of 48% and 30%, respectively. We demonstrated that compared to a baseline model, the addition of the HCT‐CI did not improve its ability to predict OS, while substituting individual comorbidities, that is, an unweighted comorbidity score, resulted in significant improvement in model performance. The factors associated with inferior outcomes were used to develop an AYA‐specific risk score.
Conclusions
The comorbidities included in the HCT‐CI as well as additional risk factors seen in younger populations need to be studied in prospective studies with the goal of validating and refining a risk score specific to AYA patients undergoing allogeneic HSCT.
“…Notably, most of these patients were asymptomatic and only had abnormal pulmonary function testing prior to transplant without signs of active infection. However, independently, a history of infection was also associated with worse outcomes in our study, and this finding corroborates prior studies . The reason why AYAs undergoing allogeneic HSCT have such a substantial rate of reduced pulmonary function is not clear, but is likely related to adverse effects from previous chemotherapeutic agents, irradiation, or infections during prior therapy .…”
Background
Adolescents and young adults (AYAs) undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have unique risk factors and poor outcomes when compared to children, but this population has not been well studied. A hematopoietic stem cell transplantation‐comorbidity index (HCT‐CI) has been developed in adults to help predict outcomes, yet this index does not seem suitable for a younger population. Therefore, we sought to examine the prevalence of various risk factors in AYAs undergoing allogeneic HSCT and determine which factors had the greatest impact on overall survival (OS) and treatment‐related mortality (TRM).
Procedures
This was accomplished by retrospectively collecting data on 241 patients who received their first allogeneic HSCT at UCLA between 2005 and 2015. We investigated the effect of multiple predictors using the Cox proportional hazards model and Fine and Gray competing risk model for OS and TRM, respectively.
Results
Our results showed that AYAs undergoing allogeneic HSCT had poor outcomes, with 5‐year OS and NRM of 48% and 30%, respectively. We demonstrated that compared to a baseline model, the addition of the HCT‐CI did not improve its ability to predict OS, while substituting individual comorbidities, that is, an unweighted comorbidity score, resulted in significant improvement in model performance. The factors associated with inferior outcomes were used to develop an AYA‐specific risk score.
Conclusions
The comorbidities included in the HCT‐CI as well as additional risk factors seen in younger populations need to be studied in prospective studies with the goal of validating and refining a risk score specific to AYA patients undergoing allogeneic HSCT.
“…These patients developed influenza infections in the months after receiving hematopoietic cell transplantations when immune cell counts were still low, and nasal wash samples were collected approximately every week. All patients were treated with the neuraminidase inhibitor oseltamivir for at least some duration of their infections (Campbell et al, 2015) (Figure 1, Figure 1—figure supplement 1). 10.7554/eLife.26875.003Figure 1.Long-term H3N2 influenza infections in four immunocompromised patients.( A ) Phylogenetic relationship between initial patient consensus sequences and 63 unique circulating influenza strains collected in the USA from 2004 to 2007, as inferred from the HA gene.…”
Viral variants that arise in the global influenza population begin as de novo mutations in single infected hosts, but the evolutionary dynamics that transform within-host variation to global genetic diversity are poorly understood. Here, we demonstrate that influenza evolution within infected humans recapitulates many evolutionary dynamics observed at the global scale. We deep-sequence longitudinal samples from four immunocompromised patients with long-term H3N2 influenza infections. We find parallel evolution across three scales: within individual patients, in different patients in our study, and in the global influenza population. In hemagglutinin, a small set of mutations arises independently in multiple patients. These same mutations emerge repeatedly within single patients and compete with one another, providing a vivid clinical example of clonal interference. Many of these recurrent within-host mutations also reach a high global frequency in the decade following the patient infections. Our results demonstrate surprising concordance in evolutionary dynamics across multiple spatiotemporal scales.DOI:
http://dx.doi.org/10.7554/eLife.26875.001
“…14,15 Respiratory viruses may be the sole cause of CAP and ARDS in some patients, or may be a risk factor predisposing patients to infections with other organisms, or may also represent concurrent upper respiratory tract infection, colonization, or prolonged viral shedding. [16][17][18][19][20]…”
Respiratory viruses are a common cause of severe pneumonia and acute respiratory distress syndrome (ARDS) in adults. The advent of new diagnostic technologies, particularly multiplex reverse transcription polymerase chain reaction, have increased the recognition of viral respiratory infections in critically ill adults. Supportive care for adults with ARDS caused by respiratory viruses is similar to the care of patients with ARDS from other causes. Although antiviral therapy is available for some respiratory viral infections, further research is needed to determine which groups of patients would benefit.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
