"Unusual" viral diseases after allogeneic hematopoietic stem cell transplantation: a multicenter, retrospective study

Abstract

Objective To observe the risk factors, clinical features, diagnosis and treatment, and prognosis of "unusual" viral diseases except "common" viruses such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) under the background of allogeneic hematopoietic stem cell transplantation dominated by haploidentical transplantation; to explore the optimal detection strategy for rare viruses. Method From April 2018 to June 2023, the "uncommon" virus disease cases other than CMV and EBV diagnosed in 3 transplant centers in China: the First Affiliated Hospital of Soochow University, the Second People's Hospital of Huai'an and the Affiliated People's Hospital of Ningbo University were retrospectively observed and analyzed. Result There were 10 cases of human adenovirus (HAdV) virus diseases, 7 cases of human herpesvirus 6 (HHV-6) virus diseases and 2 cases of human parvovirus B19 (HPV-B19) virus diseases. Up to the end of follow-up, 1 in 10 HAdV patients had survived and 9 had died, 8 of them died from viral infection and 1 died from recurrence of the primary disease. Of the 7 patients with HHV-6 virus, 6 survived and 1 died from recurrence of the primary disease. Of 2 patients with HPV-B19 virus, 1 survived and 1 died of HPV-B19 pneumonia. Conclusion CD3+T cells < 300 /ul, GVHD, ATG, the use of CD25 monoclonal antibody, pre-transplant chimeric antigen receptor T-Cell immunotherapy (CAR-T) or blinatumomab treatment history: may increase the risk of "unusual" viral disease; Pathogenic metagenomic next-generation sequencing(mNGS) of organ-specific samples has the best detection efficiency and can provide information about virus subtypes. The prognosis of HAdV-C infection and HPV-B19 systemic infection is poor, which should be paid more attention to, and high-risk patients should be screened as early as possible.