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Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes

BACKGROUND: Alloimmune-mediated lung syndromes (allo-LSs) are life-threatening complications after hematopoietic cell transplantation (HCT). Respiratory virus (RV) has been suggested to play a role in the pathogenesis. OBJECTIVE: We studied the relation between RV DNA/RNA detection in the upper/lowe...

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Autores principales: Versluys, Birgitta, Bierings, Marc, Murk, Jean Luc, Wolfs, Tom, Lindemans, Caroline, vd Ent, Kors, Boelens, Jaap Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Academy of Allergy, Asthma & Immunology 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125836/
https://www.ncbi.nlm.nih.gov/pubmed/28716387
http://dx.doi.org/10.1016/j.jaci.2017.03.055
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author Versluys, Birgitta
Bierings, Marc
Murk, Jean Luc
Wolfs, Tom
Lindemans, Caroline
vd Ent, Kors
Boelens, Jaap Jan
author_facet Versluys, Birgitta
Bierings, Marc
Murk, Jean Luc
Wolfs, Tom
Lindemans, Caroline
vd Ent, Kors
Boelens, Jaap Jan
author_sort Versluys, Birgitta
collection PubMed
description BACKGROUND: Alloimmune-mediated lung syndromes (allo-LSs) are life-threatening complications after hematopoietic cell transplantation (HCT). Respiratory virus (RV) has been suggested to play a role in the pathogenesis. OBJECTIVE: We studied the relation between RV DNA/RNA detection in the upper/lower airways before HCT and the occurrence of allo-LSs. METHODS: We retrospectively analyzed all HCT recipients between 2004 and 2014, in whom real-time PCR for RV was performed in nasopharyngeal aspirates (NPAs) and bronchoalveolar lavage (BAL) fluid before HCT. The main outcome of interest was the presence of an allo-LS, which was defined as idiopathic pneumonia syndrome or bronchiolitis obliterans syndrome. Other outcomes were overall survival and treatment-related mortality. We used Cox proportional hazard models, logistic regression models, and Fine-Gray competing risk regression for analyses. RESULTS: One hundred seventy-nine children (median age, 6.8 years) were included. RVs were found in 61% (41% in BAL fluid/NPAs and 20% in NPAs only). Rhinovirus was the most frequently detected RV (42%). Allo-LSs occurred in 13%. RV positivity in BAL fluid was a predictor for allo-LSs (hazard ratio, 3.8; 95% CI, 1.4-10.7; P = .01), whereas RV positivity in NPAs only was not. No other predictors were found. Grade II to IV acute graft-versus-host disease related to steroid treatment shows a trend toward a protective effect (odds ratio, 0.16; 95% CI, 0.0-1.3; P = .08). Allo-LSs significantly increased treatment-related mortality (52% ± 10% in allo-LSs and 20% ± 4% in non–allo-LSs, P = .007). CONCLUSIONS: These results show that pre-HCT BAL fluid RV positivity was a predictor for allo-LSs. Screening for RVs before HCT might identify patients at risk for allo-LSs. This could have implications for prevention and treatment and might subsequently influence the outcomes of HCT.
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spelling pubmed-71258362020-04-08 Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes Versluys, Birgitta Bierings, Marc Murk, Jean Luc Wolfs, Tom Lindemans, Caroline vd Ent, Kors Boelens, Jaap Jan J Allergy Clin Immunol Article BACKGROUND: Alloimmune-mediated lung syndromes (allo-LSs) are life-threatening complications after hematopoietic cell transplantation (HCT). Respiratory virus (RV) has been suggested to play a role in the pathogenesis. OBJECTIVE: We studied the relation between RV DNA/RNA detection in the upper/lower airways before HCT and the occurrence of allo-LSs. METHODS: We retrospectively analyzed all HCT recipients between 2004 and 2014, in whom real-time PCR for RV was performed in nasopharyngeal aspirates (NPAs) and bronchoalveolar lavage (BAL) fluid before HCT. The main outcome of interest was the presence of an allo-LS, which was defined as idiopathic pneumonia syndrome or bronchiolitis obliterans syndrome. Other outcomes were overall survival and treatment-related mortality. We used Cox proportional hazard models, logistic regression models, and Fine-Gray competing risk regression for analyses. RESULTS: One hundred seventy-nine children (median age, 6.8 years) were included. RVs were found in 61% (41% in BAL fluid/NPAs and 20% in NPAs only). Rhinovirus was the most frequently detected RV (42%). Allo-LSs occurred in 13%. RV positivity in BAL fluid was a predictor for allo-LSs (hazard ratio, 3.8; 95% CI, 1.4-10.7; P = .01), whereas RV positivity in NPAs only was not. No other predictors were found. Grade II to IV acute graft-versus-host disease related to steroid treatment shows a trend toward a protective effect (odds ratio, 0.16; 95% CI, 0.0-1.3; P = .08). Allo-LSs significantly increased treatment-related mortality (52% ± 10% in allo-LSs and 20% ± 4% in non–allo-LSs, P = .007). CONCLUSIONS: These results show that pre-HCT BAL fluid RV positivity was a predictor for allo-LSs. Screening for RVs before HCT might identify patients at risk for allo-LSs. This could have implications for prevention and treatment and might subsequently influence the outcomes of HCT. American Academy of Allergy, Asthma & Immunology 2018-02 2017-07-15 /pmc/articles/PMC7125836/ /pubmed/28716387 http://dx.doi.org/10.1016/j.jaci.2017.03.055 Text en © 2017 American Academy of Allergy, Asthma & Immunology. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Versluys, Birgitta
Bierings, Marc
Murk, Jean Luc
Wolfs, Tom
Lindemans, Caroline
vd Ent, Kors
Boelens, Jaap Jan
Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
title Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
title_full Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
title_fullStr Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
title_full_unstemmed Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
title_short Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
title_sort infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125836/
https://www.ncbi.nlm.nih.gov/pubmed/28716387
http://dx.doi.org/10.1016/j.jaci.2017.03.055
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