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Pérez A, Gómez D, Montoro J, Chorão P, Hernani R, Guerreiro M, Villalba M, Albert E, Carbonell-Asins JA, Hernández-Boluda JC, Navarro D, Solano C, Piñana JL. 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 2024; 59:1118-1126. [PMID: 38730040 DOI: 10.1038/s41409-024-02304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
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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Affiliation(s)
- Ariadna Pérez
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | - Juan Carlos Hernández-Boluda
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain.
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2
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Wang Y, Zhang X, Xu L, Wang Y, Yan C, Chen H, Chen Y, Wei F, Han W, Wang F, Wang J, Huang X, Mo X. Clinical manifestations, prognostic factors, and outcomes of adenovirus pneumonia after allogeneic hematopoietic stem cell transplantation. Virol J 2024; 21:110. [PMID: 38745209 PMCID: PMC11094961 DOI: 10.1186/s12985-024-02383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Severe pneumonia is one of the most important causes of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Adenovirus (ADV) is a significant cause of severe viral pneumonia after allo-HSCT, and we aimed to identify the clinical manifestations, prognostic factors, and outcomes of ADV pneumonia after allo-HSCT. METHODS Twenty-nine patients who underwent allo-HSCT at the Peking University Institute of Hematology and who experienced ADV pneumonia after allo-HSCT were enrolled in this study. The Kaplan-Meier method was used to estimate the probability of overall survival (OS). Potential prognostic factors for 100-day OS after ADV pneumonia were evaluated through univariate and multivariate Cox regression analyses. RESULTS The incidence rate of ADV pneumonia after allo-HSCT was approximately 0.71%. The median time from allo-HSCT to the occurrence of ADV pneumonia was 99 days (range 17-609 days). The most common clinical manifestations were fever (86.2%), cough (34.5%) and dyspnea (31.0%). The 100-day probabilities of ADV-related mortality and OS were 40.4% (95% CI 21.1%-59.7%) and 40.5% (95% CI 25.2%-64.9%), respectively. Patients with low-level ADV DNAemia had lower ADV-related mortality and better OS than did those with high-level (≥ 106 copies/ml in plasma) ADV DNAemia. According to the multivariate analysis, high-level ADV DNAemia was the only risk factor for intensive care unit admission, invasive mechanical ventilation, ADV-related mortality, and OS after ADV pneumonia. CONCLUSIONS We first reported the prognostic factors and confirmed the poor outcomes of patients with ADV pneumonia after allo-HSCT. Patients with high-level ADV DNAemia should receive immediate and intensive therapy.
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Affiliation(s)
- Yuewen Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiaohui Zhang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Lanping Xu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China
| | - Yu Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Chenhua Yan
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China
| | - Huan Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yuhong Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Fangfang Wei
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Han
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Fengrong Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Jingzhi Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiaojun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China
| | - Xiaodong Mo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China.
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3
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Kamboj M, Bohlke K, Baptiste DM, Dunleavy K, Fueger A, Jones L, Kelkar AH, Law LY, LeFebvre KB, Ljungman P, Miller ED, Meyer LA, Moore HN, Soares HP, Taplitz RA, Woldetsadik ES, Kohn EC. Vaccination of Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1699-1721. [PMID: 38498792 PMCID: PMC11095883 DOI: 10.1200/jco.24.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To guide the vaccination of adults with solid tumors or hematologic malignancies. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. RECOMMENDATIONS The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Mini Kamboj
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Kieron Dunleavy
- MedStar Georgetown University Hospital, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Abbey Fueger
- The Leukemia and Lymphoma Society, Rye Brook, NY
| | - Lee Jones
- Fight Colorectal Cancer, Arlington, VA
| | - Amar H Kelkar
- Harvard Medical School, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Per Ljungman
- Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Eric D Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Heloisa P Soares
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | | | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD
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4
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Pérez A, Montoro J, Chorão P, Gómez D, Guerreiro M, Giménez E, Villalba M, Sanz J, Hernani R, Hernández-Boluda JC, Lorenzo I, Navarro D, Solano C, Ljungman P, Piñana JL. Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy. Infection 2024:10.1007/s15010-024-02213-0. [PMID: 38653955 DOI: 10.1007/s15010-024-02213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND This retrospective study focused on analyzing community-acquired respiratory virus (CARV) infections, in particular human parainfluenza virus (hPIV) after allogeneic stem cell transplant (allo-SCT) in adults recipients. It aimed to assess the impact of ribavirin treatment, clinical characteristics, and risk factors associated with lower respiratory tract disease (LRTD) progression and all-cause mortality. PATIENTS AND METHODS The study included 230 allo-SCT recipients diagnosed with hPIV between December 2013 and June 2023. Risk factors for the development of LRTD, disease severity, and mortality were analyzed. Ribavirin treatment was administered at physician discretion in 61 out of 230 cases (27%). RESULTS Risk factors for LRTD progression in multivariate analysis were corticosteroids > 30 mg/day (Odds ratio (OR) 3.5, 95% Confidence Interval (C.I.) 1.3-9.4, p = 0.013), fever at the time of hPIV detection (OR 3.89, 95% C.I. 1.84-8.2, p < 0.001), and absolute lymphocyte count (ALC) < 0.2 × 109/L (OR 4.1, 95% C.I. 1.42-11.9, p = 0.009). In addition, the study found that ribavirin therapy significantly reduced progression to LRTD [OR 0.19, 95% C.I. 0.05-0.75, p = 0.018]. Co-infections (OR 5.7, 95% C.I. 1.4-23.5, p = 0.015) and ALC < 0.2 × 109/L (OR 17.7, 95% C.I. 3.6-87.1, p < 0.001) were independently associated with higher day + 100 after hPIV detection all-cause mortality. There were no significant differences in all-cause mortality and infectious mortality at day + 100 between the treated and untreated groups. CONCLUSION ALC, corticosteroids, and fever increased the risk for progression to LRTD while ribavirin decreased the risk. However, mortality was associated with ALC and co-infections. This study supports further research of ribavirin therapy for hPIV in the allo-HSCT setting.
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Affiliation(s)
- Ariadna Pérez
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Estela Giménez
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Juan Carlos Hernández-Boluda
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Per Ljungman
- Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet (KI), Huddinge, Sweden
| | - José Luis Piñana
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain.
- Division of Clinical Hematology, Hospital Clinico Universitario de Valencia, Avda. Blasco Ibañez, N 17, 46010, Valencia, Spain.
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5
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Pettini E, Ciabattini A, Fiorino F, Polvere J, Pastore G, Tozzi M, Montagnani F, Marotta G, Bucalossi A, Medaglini D. Spike-Specific Memory B Cell Response in Hematopoietic Cell Transplantation Recipients following Multiple mRNA-1273 Vaccinations: A Longitudinal Observational Study. Vaccines (Basel) 2024; 12:368. [PMID: 38675750 PMCID: PMC11054563 DOI: 10.3390/vaccines12040368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Preventing SARS-CoV-2 infection is of utmost importance in allogeneic hematopoietic cell transplantation patients (allo-HCT), given their heightened susceptibility to adverse outcomes associated with SARS-CoV-2 infection. However, limited data are available regarding the immune response to COVID-19 vaccines in these subjects, particularly concerning the generation and persistence of spike-specific memory response. Here, we analyzed the spike-specific memory B cells in a cohort of allo-HCT recipients vaccinated with multiple doses of the mRNA-1273 vaccine and monitored the spike-specific antibody response from baseline up to one month after the fourth dose. After the primary vaccine series, the frequency of spike-specific B cells, detected within the pool of Ig-switched CD19+ cells, significantly increased. The booster dose further induced a significant expansion, reaching up to 0.28% of spike-specific B cells. The kinetics of this expansion were slower in the allo-HCT recipients compared to healthy controls. Spike-specific IgG and ACE2/RBD binding inhibition activity were observed in 80% of the allo-HCT recipients after the first two doses, with a significant increase after the third and fourth booster doses, including in the subjects who did not respond to the primary vaccine series. Additionally, 87% of the allo-HCT recipients exhibited positive cross-inhibition activity against the BA.1 variant. Our findings provide evidence that allo-HCT recipients need repeated doses of the mRNA-1273 vaccine to induceSARS-CoV-2 specific immune response similar to that observed in healthy individuals. This is particularly crucial for vulnerable individuals who may exhibit a limited response to the primary series of SARS-CoV-2 vaccination.
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Affiliation(s)
- Elena Pettini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (F.F.); (J.P.); (G.P.); (D.M.)
| | - Annalisa Ciabattini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (F.F.); (J.P.); (G.P.); (D.M.)
| | - Fabio Fiorino
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (F.F.); (J.P.); (G.P.); (D.M.)
- Department of Medicine and Surgery, LUM University “Giuseppe Degennaro”, 70010 Bari, Italy
| | - Jacopo Polvere
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (F.F.); (J.P.); (G.P.); (D.M.)
| | - Gabiria Pastore
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (F.F.); (J.P.); (G.P.); (D.M.)
| | - Monica Tozzi
- Cellular Therapy Unit, Department of Innovation, Experimentation, Clinical and Translational Research, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (G.M.); (A.B.)
| | - Francesca Montagnani
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
- Infectious and Tropical Diseases Unit, Department of Medical Sciences, University Hospital of Siena, 53100 Siena, Italy
| | - Giuseppe Marotta
- Cellular Therapy Unit, Department of Innovation, Experimentation, Clinical and Translational Research, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (G.M.); (A.B.)
| | - Alessandro Bucalossi
- Cellular Therapy Unit, Department of Innovation, Experimentation, Clinical and Translational Research, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (G.M.); (A.B.)
| | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (F.F.); (J.P.); (G.P.); (D.M.)
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6
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Piñana JL, Tridello G, Xhaard A, Wendel L, Montoro J, Vazquez L, Heras I, Ljungman P, Mikulska M, Salmenniemi U, Perez A, Kröger N, Cornelissen J, Sala E, Martino R, Geurten C, Byrne J, Maertens J, Kerre T, Martin M, Pascual MJ, Yeshurun M, Finke J, Groll AH, Shaw PJ, Blijlevens N, Arcese W, Ganser A, Suarez-Lledo M, Alzahrani M, Choi G, Forcade E, Paviglianiti A, Solano C, Wachowiak J, Zuckerman T, Bader P, Clausen J, Mayer J, Schroyens W, Metafuni E, Knelange N, Averbuch D, de la Camara R. Upper and/or Lower Respiratory Tract Infection Caused by Human Metapneumovirus After Allogeneic Hematopoietic Stem Cell Transplantation. J Infect Dis 2024; 229:83-94. [PMID: 37440459 DOI: 10.1093/infdis/jiad268] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Human metapneumovirus (hMPV) epidemiology, clinical characteristics and risk factors for poor outcome after allogeneic stem cell transplantation (allo-HCT) remain a poorly investigated area. METHODS This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allo-HCT. RESULTS We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.
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Affiliation(s)
- Jose Luis Piñana
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Gloria Tridello
- Azienda Ospedaliera, Universitaria Integrata Verona, Verona, Italy
| | - Aliénor Xhaard
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France
| | - Lotus Wendel
- Leiden Study Unit, EBMT, Leiden, The Netherlands
| | - Juan Montoro
- Hematology División, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lourdes Vazquez
- Hematology Department, Hospital Clinico Universitario de Salamanca, Salamanca, Spain
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Dipartimento di scienze della salute, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Urpu Salmenniemi
- Hematology Department, Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ariadna Perez
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Cornelissen
- Hematology Department, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Elisa Sala
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Claire Geurten
- Hematology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
- Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Jenny Byrne
- Hematology Department, Nottingham University, Nottingham, United Kingdom
| | - Johan Maertens
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Tessa Kerre
- Hematology Department, Ghent University Hospital, Gent, Belgium
| | - Murray Martin
- Hematology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | | | - Moshe Yeshurun
- Institution of Hematology, Rabin Medical Center, Petach-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jürgen Finke
- Hematology Department, University of Freiburg, Freiburg, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hemtology and Oncology and Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Peter J Shaw
- The Children`s Hospital at Westmead, Sydney, Australia
| | | | - William Arcese
- Hematology Department, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Mohsen Alzahrani
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | | | - Carlos Solano
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology, and Hematopoietic Cell Transplantation, University of Medical Sciences, Poznan, Poland
| | | | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Pediatrics and Adolescent Medicine, University Hospital, Goethe University, Frankfurt, Germany
| | - Johannes Clausen
- Department of Internal Medicine I, Ordensklinikum Linz-Elisabethinen, Johannes Kepler University, Linz, Austria
| | - Jiri Mayer
- Masaryk University Hospital Brno, Brno, Czech Republic
| | | | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e EmatologiaGemelli Research Institute, Fondazione Policlinico Universitario Agostino Gemelli Research Institute, Roma, Italy
| | | | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Rafael de la Camara
- Hematology Department, Hospital de la Princesa, Madrid, Spain
- Hematology Department, Hospital Universitario Sanitas La Zarzuela, Madrid, Spain
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7
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Matsui T, Ogimi C. Risk factors for severity in seasonal respiratory viral infections and how they guide management in hematopoietic cell transplant recipients. Curr Opin Infect Dis 2023; 36:529-536. [PMID: 37729657 DOI: 10.1097/qco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Seasonal respiratory virus infections (RVIs) often progress to severe diseases in hematopoietic cell transplant (HCT) recipients. This review summarizes the current evidence on risk factors for the severity of RVIs in this high-risk population and provides clinical management. RECENT FINDINGS The likelihood of the respiratory viral disease progression depends on the immune status of the host and the type of virus. Conventional host factors, such as the immunodeficiency scoring index and the severe immunodeficiency criteria, have been utilized to estimate the risk of progression to severe disease, including mortality. Recent reports have suggested nonconventional risk factors, such as hyperglycemia, hypoalbuminemia, prior use of antibiotics with broad anaerobic activity, posttransplant cyclophosphamide, and pulmonary impairment after RVIs. Identifying novel and modifiable risk factors is important with the advances of novel therapeutic and preventive interventions for RVIs. SUMMARY Validation of recently identified risk factors for severe RVIs in HCT recipients is required. The development of innovative interventions along with appropriate risk stratification is critical to improve outcomes in this vulnerable population.
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Affiliation(s)
- Toshihiro Matsui
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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8
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Al-Ramahi JS, Shahzad M, Li K, DeJarnette S, Chaudhary SG, Lutfi F, Ahmed N, Balusu R, Bansal R, Abdelhakim H, Shune L, Singh AK, Abhyankar SH, McGuirk JP, Mushtaq MU. Lessons learned from COVID-19 pandemic: outcomes after SARS-CoV-2 infection in hematopoietic cell transplant and cell therapy recipients. Leuk Lymphoma 2023; 64:1981-1991. [PMID: 37574842 DOI: 10.1080/10428194.2023.2243355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
We investigated the outcomes after Coronavirus disease 2019 (COVID) in hematopoietic cell transplant (HCT) or chimeric antigen receptor-T cell (CART) therapy recipients in a single-centre study including all (n = 261)HCT/CART recipients (allogeneic-HCT 49%, autologous-HCT 40%, CART 11%). The median age was 60 (22-80) years. COVID severity was mild (74%), moderate (11%), and severe/critical (16%) with a mortality rate of 7% and a median duration of infection of 5.7 weeks. Significant predictors of COVID severe disease or mortality included concurrent infection (HR 14.9, 95% CI 2.2-5.6) and immunosuppressive therapy (OR 4.8, 95% CI 1.2-3.4).HCT/CART recipients have a higher risk of mortality with COVID and warrant vigilant interventions.
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Affiliation(s)
- Joe S Al-Ramahi
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Moazzam Shahzad
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Kevin Li
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Shaun DeJarnette
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Sibgha Gull Chaudhary
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Forat Lutfi
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Nausheen Ahmed
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Ramesh Balusu
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Rajat Bansal
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Haitham Abdelhakim
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Leyla Shune
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Anurag K Singh
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Sunil H Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Muhammad Umair Mushtaq
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
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9
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Piñana JL, Pérez A, Chorão P, Guerreiro M, García-Cadenas I, Solano C, Martino R, Navarro D. Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances. Transpl Infect Dis 2023; 25 Suppl 1:e14117. [PMID: 37585370 DOI: 10.1111/tid.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Before the COVID-19 pandemic, common community-acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well-being of allogeneic hematopoietic cell transplant (allo-HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo-HCT recipients, face when infected with SARS-CoV-2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo-HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo-HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
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Affiliation(s)
- Jose L Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Navarro
- Microbiology department, Hospital Clinico Universitario de Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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10
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Malard F, Holler E, Sandmaier BM, Huang H, Mohty M. Acute graft-versus-host disease. Nat Rev Dis Primers 2023; 9:27. [PMID: 37291149 DOI: 10.1038/s41572-023-00438-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/10/2023]
Abstract
Acute graft-versus-host disease (GVHD) is a common immune complication that can occur after allogeneic haematopoietic cell transplantation (alloHCT). Acute GVHD is a major health problem in these patients, and is associated with high morbidity and mortality. Acute GVHD is caused by the recognition and the destruction of the recipient tissues and organs by the donor immune effector cells. This condition usually occurs within the first 3 months after alloHCT, but later onset is possible. Targeted organs include the skin, the lower and upper gastrointestinal tract and the liver. Diagnosis is mainly based on clinical examination, and complementary examinations are performed to exclude differential diagnoses. Preventive treatment for acute GVHD is administered to all patients who receive alloHCT, although it is not always effective. Steroids are used for first-line treatment, and the Janus kinase 2 (JAK2) inhibitor ruxolitinib is second-line treatment. No validated treatments are available for acute GVHD that is refractory to steroids and ruxolitinib, and therefore it remains an unmet medical need.
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Affiliation(s)
- Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Ernst Holler
- University Hospital of Regensburg, Department of Internal Medicine 3, Regensburg, Germany
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Center, Translational Science and Therapeutics Division, Seattle, WA, USA
- University of Washington School of Medicine, Division of Medical Oncology, Seattle, WA, USA
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Engineering Laboratory for Stem Cell and Immunity Therapy, Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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11
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Kang KR, Kim YJ, Ahn MB, Kang HM, Kim SK, Lee JW, Chung NG, Cho B, Jeong DC, Kang JH. Shorter duration of protection and lower geometric mean titers against A/H3N2 antigen of the quadrivalent influenza vaccine in children post-allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2022; 57:1620-1622. [PMID: 35915154 PMCID: PMC9342841 DOI: 10.1038/s41409-022-01768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Kyu Ri Kang
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ye Ji Kim
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Mi Kang
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Seong Koo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Shiraiwa S, Harada K, Onizuka M, Kawakami S, Hara R, Aoyama Y, Amaki J, Ogiya D, Suzuki R, Toyosaki M, Machida S, Omachi K, Kawada H, Ogawa Y, Ando K. Risk factors for lower respiratory tract disease and outcomes in allogeneic hematopoietic stem cell transplantation recipients with influenza virus infection. J Infect Chemother 2022; 28:1279-1285. [PMID: 35691863 DOI: 10.1016/j.jiac.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/02/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Influenza virus infection (IVI) is frequent in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, and reports from several countries indicate high morbidity and mortality from progression to lower respiratory tract disease (LRTD). However, there have been no reports on IVI clinical characteristics, treatment outcomes, and risk factor for progression to LRTD among allo-HSCT recipients in Japan. METHODS We retrospectively reviewed the medical charts of allo-HSCT recipients who developed IVI between 2012 and 2019. RESULTS Forty-eight cases of IVI following allo-HSCT were identified at our institution. The median age was 42 years, and median time from allo-HSCT to IVI was 25 months. Thirty-seven patients (77.1%) were administered neuraminidase inhibitors (NAIs) as antiviral therapy within 48 h of symptom onset (early therapy), whereas 11 (22.9%) received NAI over 48 h after onset (delayed therapy). Subsequently, 12 patients (25.0%) developed LRTD after IVI. Multivariate analysis identified older age (hazard ratio [HR], 7.65; 95% confidence interval [CI], 2.22-26.3) and bronchiolitis obliterans (HR, 5.74; 95% CI, 1.57-21.0) as independent risk factors for progression to LRTD. Moreover, land-mark analysis showed that early therapy prevented progression to LRTD (11.8% vs. 45.5%, P = 0.013). The IVI-related mortality rate was 2.1%. CONCLUSIONS Early NAI treatment is recommended for reducing the risk of LRTD progression due to IVI in allo-HSTC recipients, particularly for older patients and those with bronchiolitis obliterans.
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Affiliation(s)
- Sawako Shiraiwa
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Kaito Harada
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Shohei Kawakami
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan; Department of Hematology, Ozawa Hospital, Odawara, Japan
| | - Ryujiro Hara
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan; Department of Hematology, Ebina General Hospital, Ebina, Japan
| | - Yasuyuki Aoyama
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Jun Amaki
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Daisuke Ogiya
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan; Department of Hematology, Isehara Kyodo Hospital, Isehara, Japan
| | - Rikio Suzuki
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Masako Toyosaki
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Shinichiro Machida
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Ken Omachi
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Hiroshi Kawada
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshiaki Ogawa
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
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13
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Early Cellular and Humoral Responses Developed in Oncohematological Patients after Vaccination with One Dose against COVID-19. J Clin Med 2022; 11:jcm11102803. [PMID: 35628927 PMCID: PMC9147947 DOI: 10.3390/jcm11102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/17/2022] Open
Abstract
Individuals with oncohematological diseases (OHD) may develop an impaired immune response against vaccines due to the characteristics of the disease or to its treatment. Humoral response against SARS-CoV-2 has been described to be suboptimal in these patients, but the quality and efficiency of the cellular immune response has not been yet completely characterized. In this study, we analyzed the early humoral and cellular immune responses in individuals with different OHD after receiving one dose of an authorized vaccine against SARS-CoV-2. Humoral response, determined by antibodies titers and neutralizing capacity, was overall impaired in individuals with OHD, except for the cohort of chronic myeloid leukemia (CML), which showed higher levels of specific IgGs than healthy donors. Conversely, the specific direct cytotoxic cellular immunity response (DCC) against SARS-CoV-2, appeared to be enhanced, especially in individuals with CML and chronic lymphocytic leukemia (CLL). This increased cellular immune response, developed earlier than in healthy donors, showed a modest cytotoxic activity that was compensated by significantly increased numbers, likely due to the disease or its treatment. The analysis of the immune response through subsequent vaccine doses will help establish the real efficacy of COVID-19 vaccines in individuals with OHD.
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14
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Piñana JL, López-Corral L, Martino R, Vazquez L, Pérez A, Martin-Martin G, Gago B, Sanz-Linares G, Sanchez-Salinas A, Villalon L, Conesa-Garcia V, Olave MT, Corona M, Marcos-Corrales S, Tormo M, Hernández-Rivas JÁ, Montoro J, Rodriguez-Fernandez A, Risco-Gálvez I, Rodríguez-Belenguer P, Hernandez-Boluda JC, García-Cadenas I, Ruiz-García M, Muñoz-Bellido JL, Solano C, Cedillo Á, Sureda A, Navarro D. SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders. J Hematol Oncol 2022; 15:54. [PMID: 35526045 PMCID: PMC9077637 DOI: 10.1186/s13045-022-01275-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3–6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. Results At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7–195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3–6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2–4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0–4854.93) vs 730.81 BAU/mL (range 0–56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. Conclusions Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-022-01275-7.
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Affiliation(s)
- José Luis Piñana
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain. .,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Lucia López-Corral
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lourdes Vazquez
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ariadna Pérez
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Beatriz Gago
- Hematology Division, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - Gabriela Sanz-Linares
- Hematology Division, Institut Català Oncologia-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Andrés Sanchez-Salinas
- Hematology Division, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Lucia Villalon
- Hematology Division, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - María T Olave
- Hematology Division, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Saragossa, Spain
| | | | | | - Mar Tormo
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Juan Montoro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
| | | | | | - Pablo Rodríguez-Belenguer
- Research Program on Biomedical Informatics (GRIB), Department of Experimental and Health Sciences, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan Carlos Hernandez-Boluda
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | | | | | | | - Carlos Solano
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Ángel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH) Office, Madrid, Spain
| | - Anna Sureda
- Hematology Division, Institut Català Oncologia-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - David Navarro
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Hospital Clinico Universitario de Valencia, Valencia, Spain
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15
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Piñana JL, López‐Corral L, Martino R, Montoro J, Vazquez L, Pérez A, Martin‐Martin G, Facal‐Malvar A, Ferrer E, Pascual M, Sanz‐Linares G, Gago B, Sanchez‐Salinas A, Villalon L, Conesa‐Garcia V, Olave MT, López‐Jimenez J, Marcos‐Corrales S, García‐Blázquez M, Garcia‐Gutiérrez V, Hernández‐Rivas JÁ, Saus A, Espigado I, Alonso C, Hernani R, Solano C, Ferrer‐Lores B, Guerreiro M, Ruiz‐García M, Muñoz‐Bellido JL, Navarro D, Cedillo A, Sureda A. SARS-CoV-2-reactive antibody detection after SARS-CoV-2 vaccination in hematopoietic stem cell transplant recipients: Prospective survey from the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group. Am J Hematol 2022; 97:30-42. [PMID: 34695229 PMCID: PMC8646900 DOI: 10.1002/ajh.26385] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023]
Abstract
This is a multicenter prospective observational study that included a large cohort (n = 397) of allogeneic (allo‐HSCT; (n = 311) and autologous (ASCT) hematopoietic stem cell transplant (n = 86) recipients who were monitored for antibody detection within 3–6 weeks after complete severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination from February 1, 2021, to July 20, 2021. Most patients (n = 387, 97.4%) received mRNA‐based vaccines. Most of the recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS‐CoV‐2‐reactive antibodies were observed in 242 (78%) of allo‐HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo‐HSCT recipients identified lymphopenia < 1 × 109/ml (odds ratio [OR] 0.33, 95% confidence interval [95% CI] 0.16–0.69, p = .003), active graft versus host disease (GvHD; OR 0.51, 95% CI 0.27–0.98, p = .04) and vaccination within the first year of transplant (OR 0.3, 95% CI 0.15–0.9, p = .04) associated with lower antibody detection whereas. In ASCT, non‐Hodgkin's lymphoma (NHL; OR 0.09, 95% CI 0.02–0.44, p = .003) and active corticosteroid therapy (OR 0.2, 95% CI 0.02–0.87, p = .03) were associated with lower detection rate. We report an encouraging rate of SARS‐CoV‐2‐reactive antibodies detection in these severe immunocompromised patients. Lymphopenia, GvHD, the timing of vaccine, and NHL and corticosteroids therapy should be considered in allo‐HSCT and ASCT, respectively, to identify candidates for SARS‐CoV‐2 antibodies monitoring.
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Affiliation(s)
- José Luis Piñana
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | | | - Rodrigo Martino
- Hematology Division Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Juan Montoro
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | - Lourdes Vazquez
- Hematology Division Hospital Universitario de Salamanca Salamanca Spain
| | - Ariadna Pérez
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | | | - Ana Facal‐Malvar
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | - Elena Ferrer
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
| | - María‐Jesús Pascual
- Hematology Division Hospital Regional Universitario Carlos Haya Malaga Spain
| | - Gabriela Sanz‐Linares
- Hematology Division Institut Català Oncologia‐Hospital Duran i reynals Barcelona Spain
| | - Beatriz Gago
- Hematology Division Hospital Regional Universitario Carlos Haya Malaga Spain
| | | | - Lucia Villalon
- Hematology Division Hospital Universitario Fundación Alcorcón Madrid Spain
| | | | - Maria T. Olave
- Hematology Division Hospital Clínico Universitario Lozano Blesa IIS Aragon, Zaragoza Spain
| | | | | | | | | | | | - Ana Saus
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Ildefonso Espigado
- Hematology Division Universidad de Sevilla, Hospital Universitario Virgen Macarena‐Hospital Universitario Virgen del Rocío, IBiS/CSIC Sevilla Spain
| | - Carmen Alonso
- Hematology Division Hospital Arnau de Vilanova Valencia Spain
| | - Rafael Hernani
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Carlos Solano
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
- Department of Medicine, School of Medicine University of Valencia Valencia Spain
| | - Blanca Ferrer‐Lores
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Manuel Guerreiro
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | | | | | - David Navarro
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
- Microbiology department Hospital Clinico Universitario de Valencia Valencia Spain
| | - Angel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH) Madrid Spain
| | - Anna Sureda
- Hematology Division Institut Català Oncologia‐Hospital Duran i reynals Barcelona Spain
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16
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Ljungman P. Infectious complications and vaccines. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:587-591. [PMID: 34889437 PMCID: PMC8791105 DOI: 10.1182/hematology.2021000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Infections are a major cause of morbidity and can result in mortality in long-term survivors after allogeneic hematopoietic cell transplantation. Chronic graft-versus-host disease and delayed immune reconstitution are recognized risk factors. Different strategies must be utilized depending on the individual patient's situation but include prolonged antimicrobial prophylaxis and vaccination. Some important infections due to pathogens preventable by vaccination are pneumococci, influenza, varicella-zoster virus, and SARS-CoV-2. Despite the fact that such recommendations have been in place for decades, implementation of these recommendations has been reported to be poor.
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Affiliation(s)
- Per Ljungman
- Correspondence Per Ljungman, Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, M75, Karolinska University Hospital, Huddinge, SE-14186 Stockholm, Sweden; e-mail:
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17
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Piñana JL, Vázquez L, Martino R, de la Cámara R, Sureda A, Rodríguez-Veiga R, Garrido A, Sierra J, Ribera JM, Torrent A, Mateos MV, de la Rubia J, Tormo M, Díez-Campelo M, García-Gutiérrez V, Álvarez-Larrán A, Sancho JM, MartínGarcía-Sancho A, Yañez L, Pérez Simón JA, Barba P, Abrisqueta P, Álvarez-Twose I, Bonanad S, Lecumberri R, Ruiz-Camps I, Navarro D, Hernández-Rivas JÁ, Cedillo Á, García-Sanz R, Bosch F. Spanish Society of Hematology and Hemotherapy expert consensus opinion for SARS-CoV-2 vaccination in onco-hematological patients. Leuk Lymphoma 2021; 63:538-550. [PMID: 34668835 PMCID: PMC8544670 DOI: 10.1080/10428194.2021.1992619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the midst of the COVID-19 pandemic, different vaccines in front of SARS-CoV-2 have been approved and administered in different vulnerable populations. As patients with cancer were excluded from pivotal trials of vaccination, little is known on their immunogenic response to these vaccines, particularly in patients with severely impaired immune system. In response to that uncertainty, the Spanish Society of Hematology and Hemotherapy launched an initiative aimed to provide recommendations for vaccination of the main hematological conditions. This document is based on the available information on COVID-19 outcomes, prior knowledge on vaccination in hematological patients, recent published data on serological response in oncohematological patients and expert opinions. New information about SARS-CoV-2 vaccination will be gathered in the near future, providing new scientific grounds to delineate the most adequate management of vaccination in patients with hematological diseases. The current limited data on SARS-CoV-2 vaccines in hematological patients represents a major limitation of this expert consensus opinion. In fact, the speed in which this field evolves may reduce their validity in the near future.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Lourdes Vázquez
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Sureda
- Hematology Department, Hematology Department, Institut Català d'Oncologia-Hospitalret, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Garrido
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José-María Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | - Anna Torrent
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | | | - Javier de la Rubia
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Díez-Campelo
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Juan-Manuel Sancho
- Hematology Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
| | | | - Lucrecia Yañez
- Hematology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Pere Barba
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Pau Abrisqueta
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Iván Álvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Santiago Bonanad
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Ruiz-Camps
- Infectious disease department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - David Navarro
- Department of Medicine, School of Medicine, Microbiology Service, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | | | - Ángel Cedillo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ramón García-Sanz
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesc Bosch
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
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18
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Mushtaq MU, Shahzad M, Chaudhary SG, Luder M, Ahmed N, Abdelhakim H, Bansal R, Balusu R, DeJarnette S, Divine C, Kribs R, Shune L, Singh AK, Ganguly S, Abhyankar SH, McGuirk JP. Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients. Transplant Cell Ther 2021; 27:796.e1-796.e7. [PMID: 34256172 PMCID: PMC8272625 DOI: 10.1016/j.jtct.2021.07.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/19/2021] [Accepted: 07/05/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in March 2020, and has caused more than 600,000 deaths in the United States at the time of this report. Hematopoietic stem cell transplantation (HCT) or chimeric antigen receptor T cell (CAR-T) therapy recipients have a higher risk of mortality with COVID-19 owing to profound immune dysregulation. In this study, we investigated the impact of SARS-CoV-2 in HCT/CAR-T therapy recipients. This single-center prospective study included all (n = 58) adult HCT/CAR-T recipients who were diagnosed with COVID-19 at the University of Kansas Medical Center between March 2020 and May 2021. Baseline and disease-related characteristics were ascertained from medical records. Data were analyzed using SPSS version 21 (IBM, Armonk, NY). Bivariate analyses, using the chi-square and t-test, and logistic regression analyses were conducted. The study included 58 HCT/CAR-T patients who acquired SARS-CoV-2 infection, including recipients of allogeneic HCT (n = 32), autologous HCT (n = 23), and CAR-T therapy (n = 3). The median patient age was 58 years (range, 24 to 77 years), and 64% were males. The median time from HCT/CAR-T therapy to SARS-CoV-2 infection was 17.7 months (range, 0.2 to 201.9 months), and 22% of the patients acquired SARS-CoV-2 within the first 100 days post-HCT/CAR-T therapy. The primary hematologic disorders were plasma cell (36%), myeloid (38%), and lymphoid (26%) malignancies. Myeloablative conditioning was performed in 62% of patients. Donors were autologous (45%), matched sibling (15%), matched unrelated (21%), and haploidentical (19%). Prior history of grade II-IV acute graft-versus-host disease (GVHD), active GVHD, and current immunosuppressive therapy (IST) was noted in 22%, 31%, and 36% of patients, respectively. Concurrent infections were observed in 19%. Lymphopenia (P = .049) and high serum ferritin concentration (P = .020) were associated with mortality. COVID-19 severity was mild in 50% of the patients, moderate in 22%, and severe in 28%. Clinical findings included pneumonia or abnormal chest imaging (in 50%), hypoxia (28%), intensive care unit admission (19%), and mechanical ventilation (10%). Therapies included remdesivir (in 41%), convalescent plasma (35%), dexamethasone (22%), monoclonal antibodies (19%), and tocilizumab (3%). The median duration of viral shedding (positive SARS-CoV-2 PCR) was 7.7 weeks (range, 2 to 18.7 weeks), and 2 patients had a persistent infection for >5 months post-CAR-T therapy. After a median follow-up of 6.1 months (range, 0.5-13.6 months), the mortality rate was 16% in all patients and 28% in allogeneic HCT recipients. Among 9 patients who died, the median survival after SARS-CoV-2 infection was 23 days (range, 14 to 140 days). In survivors with moderate-severe COVID-19, the median time to recovery was 4.2 weeks (range, 1.1 to 24.7 weeks). Among allogeneic HCT recipients, 5 (16%) developed subsequent pulmonary chronic GVHD necessitating systemic steroids and additional IST. Significant predictors of COVID-19 severity included allogeneic HCT (odds ratio [OR], 3.6, 95% confidence interval [CI], 1.2 to 10.8; P = .020), history of grade II-IV acute GVHD (OR, 4.6; 95% CI, 1.10 to 18.86; P = .036) and concurrent IST (OR, 5.9; 95% CI, 1.8 to 19.8; P = .004). HCT and CAR-T cell therapy recipients are at an increased risk of moderate-severe COVID-19 pneumonia and higher mortality with SARS-CoV-2 infection. Our findings confirm the need for continuing vigilance with social distancing and masks, vaccination prioritization, close monitoring, and aggressive treatment of HCT/CAR-T therapy recipients.
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Affiliation(s)
- Muhammad Umair Mushtaq
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS.
| | - Moazzam Shahzad
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Sibgha Gull Chaudhary
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Mary Luder
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Nausheen Ahmed
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Haitham Abdelhakim
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Rajat Bansal
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Ramesh Balusu
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Shaun DeJarnette
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Clint Divine
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Robert Kribs
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Leyla Shune
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Anurag K Singh
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Sunil H Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
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19
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de St. Maurice A, Martin‐Blais R, Halasa N. Preparing for the 2020-2021 influenza season. Pediatr Transplant 2021; 25:e14025. [PMID: 33904211 PMCID: PMC8237025 DOI: 10.1111/petr.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has altered health seeking behaviors and has increased attention to non-pharmaceutical interventions that reduce the risk of transmission of respiratory viruses including SARS-CoV-2 and influenza. While the potential impact of the COVID-19 pandemic on influenza is not fully known, in the Southern hemisphere influenza infection rates appear to be very low. Influenza vaccine efficacy for 2019-2020 season was comparable to prior season and influenza vaccine recommendations for pediatric immunizations remain similar to prior years. Influenza treatments continue to include neuraminidase inhibitors as well as baloxavir for treatment and in some instances prophylaxis.
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Affiliation(s)
- Annabelle de St. Maurice
- Division of Pediatric Infectious DiseasesDepartment of PediatricsUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Rachel Martin‐Blais
- Division of Pediatric Infectious DiseasesDepartment of PediatricsUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Natasha Halasa
- Division of Pediatric Infectious DiseasesDepartment of PediatricsVanderbilt University Medical CenterLos AngelesCAUSA
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20
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Piñana JL, Xhaard A, Tridello G, Passweg J, Kozijn A, Polverelli N, Heras I, Perez A, Sanz J, Berghuis D, Vázquez L, Suárez-Lledó M, Itäla-Remes M, Ozcelik T, Iturrate Basarán I, Karakukcu M, Al Zahrani M, Choi G, Cuesta Casas MA, Batlle Massana M, Viviana A, Blijlevens N, Ganser A, Kuskonmaz B, Labussière-Wallet H, Shaw PJ, Arzu Yegin Z, González-Vicent M, Rocha V, Ferster A, Knelange N, Navarro D, Mikulska M, de la Camara R, Styczynski J. Seasonal Human Coronavirus Respiratory Tract Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation. J Infect Dis 2021; 223:1564-1575. [PMID: 32860509 PMCID: PMC7499673 DOI: 10.1093/infdis/jiaa553] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Little is known about characteristics of seasonal human coronavirus (HCoV) (NL63, 229E, OC43 and HKU1) after allogeneic stem cell transplantation (allo-HCT). Patients and methods this is a collaborative Spanish and European bone marrow transplantation groups retrospective multicentre study, which included allo-HCT recipients (adults and children) with upper and/or lower respiratory tract disease (U/LRTD) caused by seasonal HCoV diagnosed through multiplex PCR assays from January 2012 to January 2019. Results We included 402 allo-HCT recipients who developed 449 HCoV U/LRTD episodes. Median age of recipients was 46 years (range 0.3-73.8 years). HCoV episodes were diagnosed at a median of 222 days after transplantation. The most common HCoV subtype was OC43 (n=170, 38%). LRTD involvement occurred in 121 episodes (27%). HCoV infection frequently required hospitalization (18%), oxygen administration (13%) and intensive care unit (ICU) admission (3%). Three-month overall mortality after HCoV detection was 7% in the whole cohort and 16% in those with LRTD. We identified 3 conditions associated with higher mortality in recipients with LRTD: absolute lymphocyte count <0.1 x10 9/mL [hazard ratio (HR), 10.8], corticosteroid (HR 4.68) and ICU admission (HR 8.22) (p<0.01). Conclusions Seasonal HCoV after allo-HCT may involve the LRTD in many instances, leading to a significant morbidity.
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Affiliation(s)
- Jose Luis Piñana
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Aliénor Xhaard
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France
| | - Gloria Tridello
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Anne Kozijn
- European Society for Blood and Marrow Transplantation Data Office Leiden, Leiden, The Netherlands
| | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | | | - Ariadna Perez
- Hematology Division, Hospital Clínico de Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Dagmar Berghuis
- Willem Alexander Children's Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | - Lourdes Vázquez
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | - Musa Karakukcu
- Erciyes University, Faculty of Medicine, Erciyes Pediatric Bone Marrow Transplant Center, Kayseri, Turkey
| | | | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Montserrat Batlle Massana
- Hematology Division, Instituto Catalan de Oncologia-Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation. Hannover Medical School, Hannover, Germany
| | | | | | - Peter J Shaw
- Children's Hospital at Westmead, Sydney, Australia
| | | | | | | | - Alina Ferster
- Children's University Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Nina Knelange
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France
| | - David Navarro
- Hematology Division, Hospital Morales Meseguer, Murcia, Spain
| | - Malgorzata Mikulska
- University of Genoa (Dipartimento di Scienze della Salute) and Istituto Nazionale per la Ricerca sul Cancro Ospedale Policlinico San Martino, Genova, Italy
| | | | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun Uniwersytet Mikołaja Kopernika, University Hospital, Bydgoszcz, Poland
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21
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Caldera F, Mercer M, Samson SI, Pitt JM, Hayney MS. Influenza vaccination in immunocompromised populations: Strategies to improve immunogenicity. Vaccine 2021; 39 Suppl 1:A15-A23. [PMID: 33422377 DOI: 10.1016/j.vaccine.2020.11.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/22/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Immunocompromised individuals are at high risk of severe illness and complications from influenza infection. For this reason, immunization using inactivated influenza vaccines is recommended for transplant patients, individuals receiving immunosuppressant treatments, and other persons with immunodeficiency. However, these immunocompromised populations are more likely to have lower and non-protective responses to annual vaccination with a standard influenza vaccine. Here, we review strategies aimed to improve the immunogenicity of influenza vaccines in immunocompromised populations. The different strategies employed have included adjuvanted vaccines, high-dose vaccines, booster doses, intradermal vaccination, and temporary discontinuation of immunosuppressant treatment regimens. High-dose trivalent, inactivated, split-virus influenza vaccine (IIV3-HD) is so far one of the leading strategies for improving vaccine responses in HIV patients, transplant patients, and persons receiving immunosuppressant therapies for inflammatory diseases. Several studies in these populations have shown stronger humoral responses with IIV3-HD than existing standard-dose trivalent vaccine, and comparable safety. Accordingly, some scientific societies have stated that high-dose influenza vaccine could be a preferred option for immunocompromised patients. However, larger randomized controlled studies are needed to validate relative immunogenicity and safety of IIV3-HD and other enhanced vaccines and vaccination strategies in immunocompromised individuals.
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Affiliation(s)
- Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | | | | | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
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22
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Common seasonal respiratory virus infections in allogeneic stem cell transplant recipients during the SARS-COV-2 pandemic. Bone Marrow Transplant 2021; 56:2212-2220. [PMID: 33947980 PMCID: PMC8093913 DOI: 10.1038/s41409-021-01319-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 02/05/2023]
Abstract
The SARS-COV-2 pandemic has led to strict and generalized transmission prevention measures that may have changed the epidemiological landscape of common seasonal respiratory virus (CSRV). Through a prospective CSRV survey program conducted from 2016 onwards in allogeneic stem cell transplant (allo-HSCT) recipients with respiratory symptoms, we aimed to analyze and compare the epidemiology and characteristics of CSRV over three consecutive periods [from February 1 to September 30 of 2018 (P1), 2019 (P2), and 2020 (P3)]. CSRV screening was performed through multiplex PCR assays during the study period. We identified 188 consecutive allo-HSCT recipients with 406 episodes screened for CSRV during the study period, of which 147 developed 300 CSRV. In P1 and P2 we diagnosed 115 (38.3%) and 145 (48.3%) CSRV episodes, respectively, whereas in P3 only 40 (13.3%) episodes were detected (p < 0.001). During P3, we observed a reduction of 80.2% in Ev/Rh, 93.3% in RSV, 80% in hIV, 96.3% HPIV, 68.4% in hMPV, 77.7% in ADV, 100% in HBoV, and 53.6% in HCoV as compared to P1 and P2. Consequently, we also observed a decline in absolute numbers of lower respiratory tract disease (68.1%), co-infections (91.7%), and hospitalizations (72.6%) during P3. We diagnosed SARS-COV-2 in nine allo-HSCT recipients, representing 23% of all CSRV detections in that period. In conclusion, we provide evidence of a significant drop in CSRV circulation during the SARS-COV-2 pandemic in our allo-HSCT recipients, indicating that prevention measures in the general population are highly effective in reducing CSRV prevalence and its complications in immunocompromised patients.
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23
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Teh BW, Leung VKY, Mordant FL, Sullivan SG, Joyce T, Harrison SJ, Khvorov A, Barr IG, Subbarao K, Slavin MA, Worth LJ. A randomised trial of two 2-dose influenza vaccination strategies for patients following autologous haematopoietic stem cell transplantation. Clin Infect Dis 2020; 73:e4269-e4277. [PMID: 33175132 DOI: 10.1093/cid/ciaa1711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Seroprotection and seroconversion rates are not well understood for 2-dose inactivated influenza vaccination (IIV) schedules in autologous haematopoietic stem cell transplantation (autoHCT) patients. MATERIALS/METHODS A randomised single-blind controlled trial of IIV in autoHCT patients in their first year post-transplant was conducted. Patients were randomised 1:1 to high dose (HD) IIV followed by standard dose (SD) vaccine (HD-SD arm) or two SD vaccines (SD-SD arm), 4 weeks apart. Haemagglutination inhibition (HI) assay for IIV strains was performed at baseline, 1, 2 and 6 months post-first dose. Evaluable primary outcomes were seroprotection (HI titre ≥40) and seroconversion (4-fold titre rise) rates and secondary outcomes: geometric mean titres (GMT), GMT ratios (GMR), adverse events, influenza-like-illness (ILI) and laboratory-confirmed influenza (LCI) rates and factors associated with seroconversion. RESULTS Sixty-eight patients were enrolled (34 per arm) with median age of 61.5 years, majority male (68%) with myeloma (68%). Median time from autoHCT to vaccination was 2.3 months. For HD-SD and SD-SD arms, percentage of patients achieving seroprotection was 75.8% and 79.4% for H1N1, 84.9% and 88.2% for H3N2 (all p>0.05) and 78.8% and 97.1% for influenza-B/Yamagata (p=0.03), respectively. Seroconversion rates, GMT and GMR, number of ILI or LCIs were not significantly different between arms. Adverse event rates were similar. Receipt of concurrent cancer therapy was independently associated with higher odds of seroconversion (OR 4.3, 95% CI 1.2-14.9, p=0.02). CONCLUSIONS High seroprotection and seroconversion rates against all influenza strains can be achieved with vaccination as early as 2 months post-autoHCT with either two-dose vaccine schedules.
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Affiliation(s)
- Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria
| | - Vivian K Y Leung
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,World Health Organization Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Francesca L Mordant
- Department of Microbiology and immunology, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sheena G Sullivan
- World Health Organization Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Trish Joyce
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Simon J Harrison
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria.,Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Arseniy Khvorov
- World Health Organization Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ian G Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kanta Subbarao
- World Health Organization Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria
| | - Leon J Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria
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24
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Los-Arcos I, Iacoboni G, Aguilar-Guisado M, Alsina-Manrique L, Díaz de Heredia C, Fortuny-Guasch C, García-Cadenas I, García-Vidal C, González-Vicent M, Hernani R, Kwon M, Machado M, Martínez-Gómez X, Maldonado VO, Pla CP, Piñana JL, Pomar V, Reguera-Ortega JL, Salavert M, Soler-Palacín P, Vázquez-López L, Barba P, Ruiz-Camps I. Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy: a position paper. Infection 2020; 49:215-231. [PMID: 32979154 PMCID: PMC7518951 DOI: 10.1007/s15010-020-01521-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is one of the most promising emerging treatments for B-cell malignancies. Recently, two CAR T-cell products (axicabtagene ciloleucel and tisagenlecleucel) have been approved for patients with aggressive B-cell lymphoma and acute lymphoblastic leukemia; many other CAR-T constructs are in research for both hematological and non-hematological diseases. Most of the patients receiving CAR-T therapy will develop fever at some point after infusion, mainly due to cytokine release syndrome (CRS). The onset of CRS is often indistinguishable from an infection, which makes management of these patients challenging. In addition to the lymphodepleting chemotherapy and CAR T cells, the treatment of complications with corticosteroids and/or tocilizumab increases the risk of infection in these patients. Data regarding incidence, risk factors and prevention of infections in patients receiving CAR-T cell therapy are scarce. To assist in patient care, a multidisciplinary team from hospitals designated by the Spanish Ministry of Health to perform CAR-T therapy prepared these recommendations. We reviewed the literature on the incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell treatment. Recommendations cover different areas: monitoring and treatment of hypogammaglobulinemia, prevention, prophylaxis, and management of bacterial, viral, and fungal infections as well as vaccination prior and after CAR-T cell therapy.
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Affiliation(s)
- Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall D'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gloria Iacoboni
- Deparment of Hematology, Vall D'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall D'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Manuela Aguilar-Guisado
- Department of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocío/CSIC/Institute of Biomedicine of Seville (IBIS), Seville, Spain
| | - Laia Alsina-Manrique
- Clinical Immunology and Primary Immunodeficiencies Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Cristina Díaz de Heredia
- Paediatric Oncology and Hematology Department, Hematopoietic Stem Cell Transplantation, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | | | - Irene García-Cadenas
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina García-Vidal
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS (Institut D'Investigacions biomèdiques Agust Pi I Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Marta González-Vicent
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Hospital Infantil Universitario "Niño Jesus", Madrid, Spain
| | - Rafael Hernani
- Department of Hematology, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | - Mi Kwon
- Haematology and Haemotherapy Department, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Xavier Martínez-Gómez
- Epidemiology Department, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Valentín Ortiz Maldonado
- Department of Hematology, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), University of Barcelona, Barcelona, Spain
| | - Carolina Pinto Pla
- Infectious Diseases Unit, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain
| | - José Luis Piñana
- Hematology Division, Hospital Universitario Y politécnico La Fe, Instituto de investigación sanitaria La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Virginia Pomar
- Infectious Disease Unit, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Juan Luis Reguera-Ortega
- Department of Haematology, University Hospital Virgen del Rocío/CSIC/Institute of Biomedicine of Seville (IBIS), Seville, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, Área Clínica Médica, Hospital Universitario Y Politécnico La Fe, Valencia, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital, Universitari Vall D'Hebron, Barcelona, Spain
| | | | - Pere Barba
- Deparment of Hematology, Vall D'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall D'Hebron, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Isabel Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall D'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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25
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Whitaker JA. Immunization Strategies to Span the Spectrum of Immunocompromised Adults. Mayo Clin Proc 2020; 95:1530-1548. [PMID: 32067801 DOI: 10.1016/j.mayocp.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 01/01/2023]
Abstract
The Advisory Committee on Immunization Practices to the US Centers for Disease Control and Prevention provides annual recommendations for routine adult immunizations. Many recommendations consider patient factors such as age, medical conditions, and medications that increase an individual's risk for infection with a vaccine-preventable disease. These factors, particularly those that lead to immunocompromise, may also alter the risk-benefit ratio for live vaccines, and/or lead to decreased vaccine immunogenicity and effectiveness. The provider may need to consider alternative vaccination strategies, including higher antigen dose vaccines, adjuvanted vaccines, avoidance of live vaccines, and careful timing of vaccination to optimize safety and effectiveness in immunocompromised populations. This thematic review discusses general principles regarding immunization of adults across the spectrum of immunocompromise, examines current guidelines and studies that support them, and outlines future research needs.
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Affiliation(s)
- Jennifer A Whitaker
- Department of Molecular Virology and Department of Microbiology and Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX.
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26
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Pérez A, Montoro J, Hernani R, Lorenzo I, Hernández‐Boluda JC, Giménez E, Gómez MD, Balaguer‐Roselló A, Gonzalez‐Barberá E, Guerreiro M, Aguilar C, Navarro D, Solano C, Sanz J, Piñana JL. Assessment of immunodeficiency scoring index performance in enterovirus/rhinovirus respiratory infection after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2020; 22:e13301. [DOI: 10.1111/tid.13301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Ariadna Pérez
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
| | - Juan Montoro
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - Rafael Hernani
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
| | - Ignacio Lorenzo
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - Juan Carlos Hernández‐Boluda
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
| | - Estela Giménez
- Microbiology Service Hospital Clínico Universitario Valencia Spain
| | - María Dolores Gómez
- Department of Microbiology School of Medicine University of Valencia Valencia Spain
| | | | - Eva Gonzalez‐Barberá
- Department of Microbiology School of Medicine University of Valencia Valencia Spain
| | - Manuel Guerreiro
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - Cristóbal Aguilar
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - David Navarro
- Department of Medicine School of Medicine University of Valencia Valencia Spain
- Microbiology Service Hospital Clínico Universitario Valencia Spain
| | - Carlos Solano
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
| | - Jaime Sanz
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
| | - José Luis Piñana
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
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27
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Montoro J, Sanz J, Lorenzo I, Balaguer-Roselló A, Salavert M, Gómez MD, Guerreiro M, González Barberá EM, Aguado C, Tofán L, Sanz GF, Sanz MA, Piñana JL. Community acquired respiratory virus infections in adult patients undergoing umbilical cord blood transplantation. Bone Marrow Transplant 2020; 55:2261-2269. [PMID: 32415227 PMCID: PMC7227453 DOI: 10.1038/s41409-020-0943-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 01/24/2023]
Abstract
Characteristics and risk factors (RFs) of community-acquired respiratory virus (CARV) infections after umbilical cord blood transplantation (UCBT) are lacking. We retrospectively analyzed CARV infections in 216 single-unit myeloablative UCBT recipients. One-hundred and fourteen episodes of CARV infections were diagnosed in 62 (29%) patients. Upper respiratory tract disease (URTD) occurred in 61 (54%) whereas lower respiratory tract disease (LRTD) in 53 (46%). The 5-year cumulative incidence of CARV infection was 29%. RFs for developing CARV infections were: prednisone-based graft-versus-host disease (GVHD) prophylaxis and grade II–IV acute GVHD. RFs analysis of CARV progression to LRTD identified 2007–2009 period and absolute lymphocyte count (ALC) < 0.5 × 109/L. ALC < 0.5 × 109/L had a negative impact on day 60 mortality in both overall CARV and those with LRTD, whereas proven LRTD was associated with higher day 60 mortality. CARV infections had a negative effect on non-relapse mortality. Overall survival at day 60 after CARV detection was significantly lower in recipients with LRTD compared with URTD (74% vs. 93%, respectively). In conclusion, CARV infections after UCBT are frequent and may have a negative effect in the outcomes, in particular in the context of lymphocytopenia.
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Affiliation(s)
- Juan Montoro
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Jaime Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ignacio Lorenzo
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | | | - Miguel Salavert
- Department of Infectious Diseases, University Hospital La Fe, Valencia, Spain
| | | | - Manuel Guerreiro
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | | | - Cristina Aguado
- Department of Laboratory Medicine, University Hospital La Fe, Valencia, Spain
| | - Luiza Tofán
- Department of Laboratory Medicine, University Hospital La Fe, Valencia, Spain
| | - Guillermo F Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Miguel A Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Department of Hematology, University Hospital La Fe, Valencia, Spain. .,CIBERONC, Instituto Carlos III, Madrid, Spain.
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28
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Piñana J, Montoro J, Aznar C, Lorenzo I, Gómez MD, Guerreiro M, Carretero C, González-Barberá EM, Balaguer-Roselló A, Sanz R, Salavert M, Navarro D, Sanz MA, Sanz G, Sanz J. The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. J Infect 2020; 80:333-341. [PMID: 31972212 PMCID: PMC7112613 DOI: 10.1016/j.jinf.2019.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/11/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023]
Abstract
Rapid detection methods used as first diagnostic test for CARVs may delayed the start of antiviral therapy in a significant number of influenza and RSV cases. Syndromic multiplex RT-PCR-based prospective clinical CARV survey in allo-HCT recipients translates into a lower mortality rate as compared to standard clinical practice based on RSV and influenza virus rapid detection test. We found that donor/recipient HLA mismatch, CARV LRTD and high-risk ISI were also associated with higher mortality.
Background There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections. Methods We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center. Results CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs. 57%, hospital admission 69% vs. 28% and lower respiratory tract 58% vs. 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs. 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs. 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n = 23, 37% vs. n = 10, 7%, p < 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12–0.7, p = 0.01]. Conclusion This study report on outcome differences when reporting retrospective vs. prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality.
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Affiliation(s)
- JoséLuis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carla Aznar
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Dolores Gómez
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Rosa Sanz
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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29
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Vaccination of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:593-609. [PMID: 31005140 DOI: 10.1016/j.idc.2019.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with hematologic malignancy or those who undergo hematopoietic stem cell transplantation experience variable degrees of immunosuppression, dependent on underlying disease, therapy received, time since transplant, and complications, such as graft-versus-host disease. Vaccination is an important strategy to mitigate onset and severity of certain vaccine-preventable illnesses, such as influenza, pneumococcal disease, or varicella zoster infection, among others. This article highlights vaccines that should and should not be used in this patient population and includes general guidelines for timing of vaccination administration and special considerations in the context of newer therapies, recent vaccine developments, travel, and considerations for household contacts.
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30
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The effect of timing on community acquired respiratory virus infection mortality during the first year after allogeneic hematopoietic stem cell transplantation: a prospective epidemiological survey. Bone Marrow Transplant 2019; 55:431-440. [PMID: 31551521 PMCID: PMC7091566 DOI: 10.1038/s41409-019-0698-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 11/08/2022]
Abstract
The effect of timing of community acquired respiratory virus (CARV) infection after allogeneic hematopoietic stem cell transplant (allo-HCT) is an as yet unsettled issue. We evaluate this issue by including all consecutive allo-HCT recipients with molecularly-documented CARV infection during the first year after transplant. The study cohort was drawn from a prospective longitudinal survey of CARV in allo-HCT recipient having respiratory symptoms conducted from December 2013 to December 2018 at two Spanish transplant centers. Respiratory viruses in upper and/or lower respiratory specimens were tested using multiplex PCR panel assays. The study cohort comprised 233 allo-HCT recipients with 376 CARV infection episodes diagnosed during the first year after allo-HCT. Overall, 60% of CARV episodes occurred within the first 6 months (227 out of 376). Thirty patients (13%) had died at 3 months after CARV detection, of which 25 (83%) were recipients developing CARV within the first 6 months after transplant. Multivariate analysis identified four risk factors for mortality: ATG used as part of conditioning regimen [odds ratio (OR) 2.8, 95% confidence interval (C.I.) 1.21-6.4, p = 0.01], CARV lower respiratory tract disease (OR 3.4, 95% C.I. 1.4-8.4, p = 0.007), CARV infection within the first 6 months of transplant (OR 3.04, 95% C.I. 1.1-8.7, p = 0.03), and absolute lymphocyte count <0.2 × 109/L (OR 2.4, 95% C.I. 1-5.3, p = 0.04). Developing CARV infection within the first 6 months was associated with higher mortality. Our data supports that the timing of CARV development after allo-HCT could be of major interest.
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31
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Ison MG, Hirsch HH. Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs. Clin Microbiol Rev 2019; 32:e00042-19. [PMID: 31511250 PMCID: PMC7399564 DOI: 10.1128/cmr.00042-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.
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Affiliation(s)
- Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Piñana JL, Gómez MD, Montoro J, Lorenzo I, Pérez A, Giménez E, González-Barberá EM, Carretero C, Guerreiro M, Salavert M, Sanz G, Hernández-Boluda JC, Borrás R, Sanz J, Solano C, Navarro D. Incidence, risk factors, and outcome of pulmonary invasive fungal disease after respiratory virus infection in allogeneic hematopoietic stem cell transplantation recipients. Transpl Infect Dis 2019; 21:e13158. [PMID: 31402532 PMCID: PMC7169787 DOI: 10.1111/tid.13158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/04/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is growing evidence that community-acquired respiratory virus (CARV) increases the risk of pulmonary invasive fungal disease (IFD) in the allogeneic hematopoietic stem cell transplantation (allo-HSCT) setting. To date, there is a lack of knowledge regarding the risk factors (RFs), as well as the most critical period for subsequent onset of IFD after CARV infections in allo-HSCT recipients. METHODS In this prospective longitudinal observational CARV survey, we analyzed the effect of CARV on subsequent IFD development in 287 adult allo-HSCT recipients diagnosed with 597 CARV episodes from December 2013 to December 2018. Multiplex PCR panel assays were used to test CARVs in respiratory specimens. FINDINGS Twenty-nine out of 287 allo-HSCT recipients (10%) developed IFD after a CARV episode. The median time of IFD onset was 21 days (range, 0-158 days) from day of the first CARV detection. Generalized estimating equation model identified 4 risk factors for IFD: ATG-based conditioning regimen [odds ratio (OR) 2.34, 95% confidence interval (CI) 1.05-5.2, P = .038], CARV lower respiratory tract disease (OR 10.6, 95% CI 3.7-30.8, P < .0001), CARV infection during the first year after transplant (OR 5.34, 95% CI 1.3-21.8, P = .014), and corticosteroids during CARV (OR 2.6, 95% CI 1.1-6.3, P = .03). CONCLUSION Allo-HSCT recipients conditioned with ATG and under corticosteroid therapy at the time of CARV LRTD during the first year after transplant may require close monitoring for subsequent IFD.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - María Dolores Gómez
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | - Estela Giménez
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | | | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Rafael Borrás
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
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Fontana L, Strasfeld L. Respiratory Virus Infections of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:523-544. [PMID: 30940462 PMCID: PMC7126949 DOI: 10.1016/j.idc.2019.02.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Respiratory virus infections in hematologic stem cell transplant recipients and patients with hematologic malignancies are increasingly recognized as a cause of significant morbidity and mortality. The often overlapping clinical presentation makes molecular diagnostic strategies imperative for rapid diagnosis and to inform understanding of the changing epidemiology of each of the respiratory viruses. Most respiratory virus infections are managed with supportive therapy, although there is effective antiviral therapy for influenza. The primary focus should remain on primary prevention infection control procedures and isolation precautions, avoidance of ill contacts, and vaccination for influenza.
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Affiliation(s)
- Lauren Fontana
- Division of Infectious Disease, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L457, Portland, OR 97239, USA.
| | - Lynne Strasfeld
- Division of Infectious Disease, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L457, Portland, OR 97239, USA
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