Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant‐related mortality

Abstract

Summary Viral respiratory infections (VRIs) contribute to the morbidity and transplant‐related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre‐HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.

Rhinovirus Infections among Hematopoietic Stem Cell Transplant Recipients: A Pre-Transplant Dilemma?

“…Pre-transplant respiratory viral infections are of particular concern, as they can challenge the transplantation procedure. Yet, in a retrospective study among 585 pediatric patients benefiting from allo-HSCT, transplant delay for patients with a positive screening test for cytomegalovirus, ADV, RSV, FLU, PIV, or hMPV led to a better overall survival rate (79% versus 54%) and a reduced transplant-related mortality rate (7% versus 26%) [11]. Another retrospective multicentric study including 402 adult and pediatric patients with pre-transplant HCoV infections found similar results; HCoV lower respiratory tract infections led to a higher three-month overall mortality (16%) compared to HCoV upper respiratory tract infections (7%) [12].…”

Clinical value of plasma and peripheral blood mononuclear cells Epstein–Barr Virus DNA dynamics on prognosis of allogeneic stem cell transplantation

“…We expect prompt and effective prevention of impending EBV-PTLD after HSCT by using the EBV DNA threshold value. Epstein-Barr virus (EBV) infection were significantly associated with poorer survival and higher TRM for HSCT patients Ottaviano et al, 2020). Our findings demonstrated that patients with intermediate-level of EBV DNA load presented in PBMCs and plasma were associated with better prognosis in terms of OS and TRM after HSCT, especially when compared with the high EBV-level group.…”

Respiratory viral infections prior to and after allogeneic haematopoietic cell transplantation

“…The literature on these issues is limited and therefore it is most welcome to discuss the paper of Ottaviano et al (), which analyses the impact of pre‐transplant respiratory virus infections on transplant outcome in children. Obviously, an important question is, whether findings can be generalized to the adult population.…”

“…In this study (Ottaviano et al , ), approximately 600 children were screened pret‐ransplant for respiratory viruses. Of 75 positive patients, transplant was delayed in 33% whereas conditioning was started immediately in the remainder.…”

“…Previous studies (e.g., Campbell et al , ) had shown higher mortality with pre‐existing viral infection. Ottaviano et al () also looked at the effect of delaying HCT; this appears, if feasible, to improve prognosis. The advantage of this study is that the effect size of delaying the transplant is quantified.…”