Significant Transplantation-Related Mortality from Respiratory Virus Infections within the First One Hundred Days in Children after Hematopoietic Stem Cell Transplantation
Significant Transplantation-Related Mortality from Respiratory Virus Infections within the First One Hundred Days in Children after Hematopoietic Stem Cell Transplantation
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DOI：
10.1016/j.bbmt.2015.06.015
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发表时间：
2015-10-01
影响因子：
4.3
通讯作者：
Gassas, Adam
中科院分区：
文献类型：
--
作者：
Hutspardol, Sakara;Essa, Mohammed;Gassas, Adam
呼吸道病毒感染（RVI）在造血干细胞移植（HSCT）中很重要，有关其发病率、发病率、死亡率和长期肺部并发症的知识有限。我们报告了一项研究，以评估接受HSCT的儿童中RVI的短期和长期发生率和结局。在2000年1月至2012年12月期间，844名患者在患病儿童医院接受了造血干细胞移植（HSCT）：491名为同种异体，353名为自体。在对844例患者进行HSCT后第一年的死因筛查时，我们发现RVI作为死亡原因仅在HSCT后的前100天内明显。发现54例（6.5%）患者在HSCT后前100天内发生RVI（同种异体= 32例，自体= 22例）。分别有31例（57%）和23例（43%）患者记录了上呼吸道和下呼吸道感染。病毒为副流感病毒（35%）、呼吸道合胞病毒（28%）、流感病毒（22%）、腺病毒（7%）、人偏肺病毒（4%）、冠状病毒（2%）和鼻病毒（2%）。3例患者在第100天前复发原发病，被排除。其余51例患者的总死亡率为10%（同种异体= 4，自体= 1）。所有5例死亡均直接归因于RVI，所有5例死亡均发生在下呼吸道感染患者中。其余患者的中位随访时间为4.3年（范围：1.4 - 11.8年），未观察到慢性肺部并发症。收缩RVI的明显季节性模式是显而易见的，总RVI的65%发生在10月至3月之间（427例中的35例与417例中的19例，P = .03）。考虑到RVI的显著死亡率和预防的挑战，尽可能选择开始HSCT的时间可能有助于预防RVI并改善结局。(C)2015年美国血液和骨髓移植协会。
Respiratory viral infections (RVI) are important in hematopoietic stem cell transplantations (HSCT) and knowledge regarding incidence, morbidity, mortality, and long-term pulmonary complications is limited. We report a study to evaluate incidence and outcomes, both short and long-term, of RVI in children receiving HSCT. Between January 2000 and December 2012, 844 patients underwent hematopoietic stem cell transplantation (HSCT) at the Hospital for Sick Children: 491 were allogeneic and 353 were autologous. When screening for causes of death in the first year after HSCT in the 844 patients, we found that RVI as a cause of death was only evident in the first 100 days after HSCT. Fifty-four (6.5%) patients were found to have an RVI within the first 100 days after HSCT (allogeneic = 32, autologous = 22). Upper and lower respiratory tract infections were documented in 31 (57%) and 23 (43%) patients, respectively. Viruses were parainfluenza (35%), respiratory syncytial virus (28%), influenza (22%), adenovirus (7%), human metapneumovirus (4%), coronavirus (2%), and rhinovirus (2%). Three patients relapsed with their primary disease before day 100 and were excluded. The overall mortality for the remaining 51 patients was 10% (allogeneic = 4, autologous = 1). All 5 deaths were directly attributable to RVI and all 5 deaths occurred in patients with a lower respiratory tract infection. The remaining patients were followed for a median of 4.3 years (range, 1.4 to 11.8) and no chronic pulmonary complications were observed. A clear seasonal pattern for contracting RVI was evident with 65% of total RVI occurring between October and March (35 of 427 versus 19 of 417, P = .03). Given the significant mortality from RVI and the challenges in preventing them, choosing the time to start HSCT, whenever possible, may help prevent RVI and improve outcomes. (C) 2015 American Society for Blood and Marrow Transplantation.