Abstract
In the general population, influenza virus, respiratory syncytial virus, and SARS-CoV-2 are considered the most severe community-acquired respiratory viruses (CARVs). However, allogeneic stem cell transplant (allo-SCT) recipients may also face severe courses from other CARVs. This retrospective study compared outcomes of various CARV lower respiratory tract diseases (LRTD) in 235 adult allo-SCT recipients, excluding co-infection episodes. We included 235 adults allo-SCT recipients experiencing 353 CARV LRTD consecutive episodes (130 rhinovirus, 63 respiratory syncytial virus, 43 influenza, 43 human parainfluenza virus, 23 human metapneumovirus, 19 Omicron SARS-CoV-2, 17 common coronavirus, 10 adenovirus and 5 human bocavirus) between December 2013 and June 2023. Day 100 overall survival ranged from 78% to 90% without significant differences among CARV types. Multivariable analysis of day 100 all-cause mortality identified corticosteroid use of >1 to <30 mg/d [Hazard ratio (HR) 2.45, p = 0.02) and ≥30 mg/d (HR 2.20, p = 0.015) along with absolute lymphocyte count <0.2 × 109/L (HR 5.82, p < 0.001) and number of CARV episodes as a continuous variable per one episode increase (HR 0.48, p = 0.001) as independent risk factors for all-cause mortality. Degree of immunosuppression, rather than intrinsic CARV virulence, has the most significant impact on mortality in allo-SCT recipients with CARV-LRTD.
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Data available upon formal request by email to JLP.
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Authors responsible for study conception and design: Jose Luis Piñana and Ariadna Perez. Authors who performed the data analysis and generated the tables and figures: Jose Luis Piñana. Authors responsible for patient recruitment: José Luis Piñana, Juan Montoro, Ariadna Pérez, Pedro Chorão, Dolores Gómez, Manuel Guerreiro, Marta Villalba, and Rafael Hernani. Authors responsible for writing the manuscript: Jose Luis Piñana, Ariadna Perez, David Navarro, Dolores Gomez, Eliseo Albert, and Carlos Solano were responsible for writing and supervising the writing of the manuscript. All co-authors were responsible for reviewing the analysis interpretation, suggesting modifications to the text, critically reviewing the manuscript, and for the final approval of the manuscript.
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The local research ethics committee of the Hospital Clínico Universitario of Valencia approved the registry and study protocol (reference code 2019/351).
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Pérez, A., Gómez, D., Montoro, J. et al. Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease. Bone Marrow Transplant 59, 1118–1126 (2024). https://doi.org/10.1038/s41409-024-02304-4
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DOI: https://doi.org/10.1038/s41409-024-02304-4