High Mortality Rates in Allogeneic Hematopoietic Cell Transplant Recipients With Pulmonary Impairment

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Screening for pulmonary impairment following respiratory viral infection may help identify patients at high risk for transplant-related mortality.
Screening for pulmonary impairment following respiratory viral infection may help identify patients at high risk for transplant-related mortality.

Pulmonary impairment following respiratory viral infection (RVI) may be associated with high nonrelapse mortality (NRM) at 2 years after allogeneic hematopoietic cell transplant (alloHCT), according to a study published in Biology of Blood and Marrow Transplantation.

Researchers defined pulmonary impairment following RVI as a decline in forced expiratory volume in 1 second by at least 10%. They assessed 223 alloHCT recipients with respiratory syncytial virus, parainfluenza virus, or influenza who were treated at the University of Texas MD Anderson Cancer Center between 2004 and 2013. All patients had pulmonary function test results documented both prior to and after RVI.

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By 1 year after RVI, 75 patients had developed significant pulmonary impairment. Increased odds of pulmonary impairment were associated with chronic graft-versus-host disease (odds ratio [OR], 2.8; P =.003) and lymphopenia (OR, 2.2; P =.02).

At 2 years after RVI, 71 patients had died, 31 of whom had NRM. NRM at 2 years among patients with lung impairment was 25.3% compared with 7.4% in patients without impairment. Increased age, systemic steroid use, and significant pulmonary impairment following RVI were associated with increased 2-year NRM in multivariable analysis. Patients who developed pulmonary impairment within 90 days of RVI had similar 2-year NRM compared with patients who developed pulmonary impairment more than 90 days after RVI.

Of note, compared with study patients, those who were excluded from analysis due to missing pulmonary function test PFT data were more likely to have higher all-cause mortality (53% vs 32%; P <.001) and NRM (31% vs 13%; P <.001) at  2 years  after RVI.

It is common for RVI in HCT recipients to progress to a lower respiratory tract infection, resulting in high mortality rates. The authors therefore suggested that screening for lung impairment could help identify recipients of HCT at high risk for NRM.

Reference

1. Sheshadri A, Chemaly RF, Alousi AM, et al. Pulmonary impairment following respiratory viral infections is associated with high mortality in allogeneic hematopoietic cell transplant recipients [published online December 3, 2018]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2018.11.022

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