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Busca A, Marchesi F, Cattaneo C, Trecarichi EM, Delia M, Del Principe MI, Candoni A, Pagano L. When Viruses Meet Fungi: Tackling the Enemies in Hematology. J Fungi (Basel) 2022; 8:jof8020184. [PMID: 35205938 PMCID: PMC8875273 DOI: 10.3390/jof8020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
The association of invasive fungal infections (IFI) and viral infections has been described in patients with hematologic malignancies (HM), in particular in hematopoietic stem cell transplant recipients. Regrettably, the diagnosis is often challenging, making the treatment inappropriate in some circumstances. The present review takes into consideration the viral infections commonly associated with IFI. Clinical presentation of IFI and viral infections, risk factors, and impact on the outcome of HM patients are discussed throughout the paper.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Unit, AOU Citta’ della Salute e della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, University “Magna Graecia”—“Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, 70124 Bari, Italy;
| | | | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University of Udine-ASUFC, 33100 Udine, Italy;
| | - Livio Pagano
- Unità di Ematologia Geriatrica ed Emopatie Rare, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Calderón-Parra J, Moreno-Torres V, Mills-Sanchez P, Tejado-Bravo S, Romero-Sánchez I, Balandin-Moreno B, Calvo-Salvador M, Portero-Azorín F, García-Masedo S, Muñez-Rubio E, Ramos-Martinez A, Fernández-Cruz A. Association of COVID-19-Associated Pulmonary Aspergillosis with Cytomegalovirus Replication: A Case–control Study. J Fungi (Basel) 2022; 8:jof8020161. [PMID: 35205914 PMCID: PMC8877274 DOI: 10.3390/jof8020161] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction: Cytomegalovirus (CMV) infection is a well-known factor associated with invasive aspergillosis in immunocompromised hosts. However, its association with COVID-19-associated pulmonary aspergillosis (CAPA) has not been described. We aimed to examine the possible link between CMV replication and CAPA occurrence. Methods: A single-center, retrospective case–control study was conducted. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. Two controls were selected for each case among critically ill COVID-19 patients. Results: In total, 24 CAPA cases were included, comprising 14 possible CAPA and 10 probable CAPA. Additionally, 48 matched controls were selected. CMV replication was detected more frequently in CAPA than in controls (75.0% vs. 35.4%, p = 0.002). Probable CMV end-organ disease was more prevalent in CAPA (20.8% vs. 4.2%, p = 0.037). After adjusting for possible confounding factors, CMV replication persisted strongly associated with CAPA (OR 8.28 95% CI 1.90–36.13, p = 0.005). Among 11 CAPA cases with CMV PCR available prior to CAPA, in 9 (81.8%) cases, CMV replication was observed prior to CAPA diagnosis. Conclusions: Among critically ill COVID-19 patients, CMV replication was associated with CAPA and could potentially be considered a harbinger of CAPA. Further studies are needed to confirm this association.
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Affiliation(s)
- Jorge Calderón-Parra
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
- Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), 28222 Madrid, Spain
- Correspondence:
| | - Victor Moreno-Torres
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
- Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), 28222 Madrid, Spain
| | - Patricia Mills-Sanchez
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
| | - Sandra Tejado-Bravo
- Intensive Care Unit, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (S.T.-B.); (B.B.-M.)
| | - Isabel Romero-Sánchez
- Microbiology Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - Bárbara Balandin-Moreno
- Intensive Care Unit, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (S.T.-B.); (B.B.-M.)
| | - Marina Calvo-Salvador
- Pharmacy Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (M.C.-S.); (F.P.-A.); (S.G.-M.)
| | - Francisca Portero-Azorín
- Pharmacy Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (M.C.-S.); (F.P.-A.); (S.G.-M.)
| | - Sarela García-Masedo
- Pharmacy Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (M.C.-S.); (F.P.-A.); (S.G.-M.)
| | - Elena Muñez-Rubio
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
| | - Antonio Ramos-Martinez
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (V.M.-T.); (P.M.-S.); (E.M.-R.); (A.R.-M.); (A.F.-C.)
- Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), 28222 Madrid, Spain
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3
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Kimura SI, Tamaki M, Okinaka K, Seo S, Uchida N, Igarashi A, Ozawa Y, Ikegame K, Eto T, Tanaka M, Shiratori S, Nakamae H, Sawa M, Kawakita T, Onizuka M, Fukuda T, Atsuta Y, Kanda Y, Nakasone H. Cytomegalovirus reactivation is associated with an increased risk of late-onset invasive aspergillosis independently of grade II-IV acute graft-versus-host disease in allogeneic hematopoietic stem cell transplantation: JSTCT Transplant Complications Working Group. Ann Hematol 2021; 100:3029-3038. [PMID: 34490500 DOI: 10.1007/s00277-021-04660-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
There is a matter of debate about the clinical impact of cytomegalovirus (CMV) reactivation on the development of late-onset invasive aspergillosis (IA), which occurs 40 days or later after allogeneic hematopoietic stem cell transplantation (HSCT). Using a Japanese transplant registry database, we analyzed the risk factors for the development of late-onset IA in 21,015 patients who underwent their first allogeneic HSCT between 2006 and 2017. CMV reactivation was defined as the initiation of preemptive anti-CMV antiviral therapy. Overall, there were 582 cases of late-onset IA, which occurred at a median of 95 days after HSCT. The 2-year cumulative incidence was 3.4% (95% confidence interval (CI), 3.0-3.9) in patients with CMV reactivation within 40 days after HSCT and 2.5% (95% CI, 2.3-2.8) in those without it (P < 0.001). In a multivariate analysis, CMV reactivation as a time-dependent covariate was significantly associated with the development of late-onset IA (hazard ratio (HR) 1.40, P < 0.001), as well as grade II-IV acute GVHD, age > 50 and HCT-CI ≥ 3 in the entire cohort. If we focus on the subgroup without grade II-IV acute GVHD, which is generally an indication for systemic corticosteroid therapy (n = 12,622), CMV reactivation was still a significant factor for the development of late-onset IA (HR 1.37, P = 0.045) as well as age > 50 years, HCT-CI ≥ 3, and cord blood transplantation. In conclusion, CMV reactivation was associated with an increased risk of late-onset IA after allogeneic HSCT independently of acute GVHD. Close monitoring for late-onset IA is necessary for patients who develop CMV reactivation even without grade II-IV acute GVHD.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama-city, Saitama, 330-8503, Japan. .,Transplant Complications Working Group of the Japanese Society for Transplantation and Cellular Therapy (JSTCT), Aichi, Japan.
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama-city, Saitama, 330-8503, Japan.,Transplant Complications Working Group of the Japanese Society for Transplantation and Cellular Therapy (JSTCT), Aichi, Japan
| | - Keiji Okinaka
- Transplant Complications Working Group of the Japanese Society for Transplantation and Cellular Therapy (JSTCT), Aichi, Japan.,Department of General Medicine and Infectious Diseases, National Cancer Center Hospital East, Chiba, Japan.,Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Sachiko Seo
- Transplant Complications Working Group of the Japanese Society for Transplantation and Cellular Therapy (JSTCT), Aichi, Japan.,Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Souichi Shiratori
- Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan
| | - Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takahiro Fukuda
- Transplant Complications Working Group of the Japanese Society for Transplantation and Cellular Therapy (JSTCT), Aichi, Japan.,Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama-city, Saitama, 330-8503, Japan.,Division of Hematology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama-city, Saitama, 330-8503, Japan.,Transplant Complications Working Group of the Japanese Society for Transplantation and Cellular Therapy (JSTCT), Aichi, Japan
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4
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Takeshita J, Kimura SI, Nakasone H, Kawamura S, Nakamura Y, Kawamura M, Yoshino N, Misaki Y, Yoshimura K, Matsumi S, Gomyo A, Tamaki M, Akahoshi Y, Kusuda M, Kameda K, Wada H, Sato M, Kako S, Kanda Y. Association between the kinetics of cytomegalovirus reactivation in terms of the area under the curve of cytomegalovirus antigenemia and non-relapse mortality after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2021; 23:e13715. [PMID: 34437758 DOI: 10.1111/tid.13715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We assessed the kinetics of cytomegalovirus (CMV) reactivation using the area under the curve (AUC), which simultaneously reflects both the viral load at each time point and the duration of CMV antigenemia (CMV-AG). METHODS We performed a single-institute retrospective analysis in patients who received allogeneic hematopoietic stem cell transplantation (HSCT) between 2007 and 2017 and survived more than 100 days after HSCT. The AUC of CMV-AG (CMV-AUC) was calculated by a trapezoidal method using the number of CMV-AG tested by the C10/C11 method after logarithmic transformation, and plotted weekly up to day 100. RESULTS CMV reactivation was observed in 195 cases and the median CMV-AUC for CMV-reactivated patients was 8.7 (range 0.5-30.7). Older age, corticosteroid administration, CMV-seropositive transplant recipients, HSCT from an unrelated donor, and underlying diseases were independent predictive factors for higher CMV-AUC. Higher CMV-AUC was associated with poor overall survival (OS) with borderline significance in a univariate analysis (p = .07), but was not significant in a multivariate analysis. Older age, high-risk disease status, and female gender were identified as significant factors associated with poor OS in this study. On the other hand, CMV-AUC (hazard ratio: no reactivation reference, low 0.98, high 2.49, p < .01), older age, HCT-CI ≥3, and corticosteroid administration were identified as significant factors associated with increased incidence of non-relapse mortality (NRM). CONCLUSIONS The kinetics of CMV reactivation in terms of CMV-AUC reflect both the severity and duration of CMV reactivation. High CMV-AUC was associated with an increased incidence of NRM in survivors over 100 days.
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Affiliation(s)
- Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yuhei Nakamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shimpei Matsumi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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5
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Stern A, Su Y, Dumke H, Fang J, Tamari R, Jakubowski A, Cho C, Giralt S, Perales MA, Papanicolaou GA. CMV viral load kinetics predict CMV end-organ disease and mortality after hematopoietic cell transplant (HCT). J Infect Dis 2021; 224:620-631. [PMID: 33864371 DOI: 10.1093/infdis/jiab212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We investigated the association between time-averaged area under the curve (AAUC) of CMV viral load (VL) by D100 and overall survival (OS) at one-year post-hematopoietic cell transplantation (HCT). METHODS A retrospective cohort study, including patients receiving HCT between 2010.6 and 2017.12 from Memorial Sloan Kettering Cancer Center. AAUC was calculated for patients with detected VL. Patients were categorized into "non-controllers" (Q4) and "controllers" (Q1-3) using the highest AAUC quartile as cutoff. Kaplan-Meier analyses and Cox models were used to estimate the association between AAUC and OS. Patients with non-detected CMV VL were categorized into "elite-controllers" (R+ or R-/D+) and "R-/D-". RESULTS The study (N=952) included 282 controllers, 93 non-controllers, 275 elite-controllers, and 302 R-/D-. OS was 80.1% and 58.1% for controllers and non-controllers, respectively. In multivariable models, non-controllers had worse OS versus controllers (adjusted hazard ratio [HR] 2.65, 95% CI 1.71-4.12). In landmark analyses, CMV controllers had similar OS as elite-controllers (HR 1.26, 95% CI 0.83-1.91) or R-/D- (HR 0.98, 95% CI 0.64-1.5). CONCLUSION CMV non-controllers had worse OS at one-year post-HCT. CMV controllers had similar OS as elite-controllers or R-/D-. Future studies are needed to validate our AAUC cutoff across different cohorts and CMV management strategies.
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Affiliation(s)
- Anat Stern
- Memorial Sloan Kettering Cancer Center, Infectious Disease Service, New York, NY, United States
| | - Yiqi Su
- Memorial Sloan Kettering Cancer Center, Infectious Disease Service, New York, NY, United States
| | - Henry Dumke
- Memorial Sloan Kettering Cancer Center, Infectious Disease Service, New York, NY, United States
| | - Jiaqi Fang
- Memorial Sloan Kettering Cancer Center, Infectious Disease Service, New York, NY, United States
| | - Roni Tamari
- Memorial Sloan Kettering Cancer Center, Adult Bone Marrow Transplant Service, New York, NY, United States.,Weill Cornell Medical College, Cornell University, New York, NY, United States
| | - Ann Jakubowski
- Memorial Sloan Kettering Cancer Center, Adult Bone Marrow Transplant Service, New York, NY, United States.,Weill Cornell Medical College, Cornell University, New York, NY, United States
| | - Christina Cho
- Memorial Sloan Kettering Cancer Center, Adult Bone Marrow Transplant Service, New York, NY, United States.,Weill Cornell Medical College, Cornell University, New York, NY, United States
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, Adult Bone Marrow Transplant Service, New York, NY, United States.,Weill Cornell Medical College, Cornell University, New York, NY, United States
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, Adult Bone Marrow Transplant Service, New York, NY, United States.,Weill Cornell Medical College, Cornell University, New York, NY, United States
| | - Genovefa A Papanicolaou
- Memorial Sloan Kettering Cancer Center, Infectious Disease Service, New York, NY, United States.,Weill Cornell Medical College, Cornell University, New York, NY, United States
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