Respiratory Virus Infections of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient

Abstract

Respiratory virus infections (RVIs) are increasingly recognized as a cause of significant morbidity and mortality in recipients of hematologic stem cell transplant (HCT) and patients with hematologic malignancy (HM). 1,2 With now widespread use of molecular diagnostics, the epidemiology and spectrum of clinical disease of these infections can be better characterized. Apart from influenza, the currently available antivirals are limited in efficacy and/or associated with potential for toxicity, thus emphasizing the importance of prevention strategies. This article provides a review of the epidemiology, clinical characteristics, management, and prevention of RVIs in HCT recipients and HM patients.No disclosures. KEYWORDS Respiratory virus infection Hematopoietic stem cell transplant RSV Influenza Parainfluenza Human metapneumovirus Rhinovirus Coronavirus KEY POINTSThe morbidity and associated complications of respiratory virus infections are greater in hematopoietic stem cell transplant recipients and patients with hematologic malignancy than in immunocompetent individuals, with severity of illness related to the degree of immunosuppression. Molecular microbiologic testing is the gold standard for diagnosis, allowing differentiation of what are largely overlapping clinical syndromes. Most of the respiratory viruses, apart from influenza and in some circumstances respiratory syncytial virus and adenovirus, are managed supportively. Prevention is key and should focus on vaccination for influenza, avoidance of ill contacts, and compliance with principles of infection control.Infect Dis Clin N Am 33 (2019) 523-544 a Studies are a combination of PCR and traditional laboratory methods (eg, culture, direct fluorescent antibody, and enzyme immunoassay). b PCR-based studies. c Includes all-cause and attributable mortality with variable timeframe to death. d One mortality in a coinfected patient attributed to enterovirus/rhinovirus infection.

The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation

“…[10][11][12] In these patients, StCP focused on influenza and RSV seems suboptimal since this strategy led to significant mortality rates after any CARV LRTD ranging from 6% to 83%. [13][14][15][16][17] This fact emphasize that actions are required to improve outcomes in this scenario.…”

Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

“…The use of new antineoplastic agents, particularly novel targeted therapies, has improved overall survival. However, these therapies have side effects on humoral and cell-mediated immunity, increasing the risk of infections caused by viral agents [13]. To date, few data are available on COVID-19 in patients with hematologic malignancies.…”

Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

“…However, these therapies have side-effects on humoral and cell-mediated immunity, increasing the risk of infections caused by viral agents. (13) To date, few data are available on COVID-19 in patients with hematologic malignancies. Reported studies have focused on hospitalized patients.…”