Pulmonary Impairment after Respiratory Viral Infections Is Associated with High Mortality in Allogeneic Hematopoietic Cell Transplant Recipients

Ajay Sheshadri, Roy F. Chemaly, Amin M. Alousi, Pankil K. Shah, Gabriela Rondon, Lara Bashoura, Joumana Kmeid, Jacques Azzi, David W. Blanco, Maryam Kaous, Burton F. Dickey, Richard E. Champlin, Dimpy P Shah

Research output: Contribution to journalArticle

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Abstract

Pulmonary impairment predicts increased mortality in many settings, and respiratory viral infection (RVI) causes considerable morbidity and mortality in allogeneic hematopoietic cell transplant recipients (allo-HCT). We hypothesized that pulmonary impairment after RVI, defined as a decline of forced expiratory volume in 1 second values by ≥10%, may identify allo-HCT recipients at high risk for mortality. We studied all allo-HCT recipients at our institution who had RVI with respiratory syncytial virus, parainfluenza virus, or influenza from 2004 to 2013 and had pre-RVI and post-RVI pulmonary function tests. We used competing risk regression models to identify risk factors for 2-year nonrelapse mortality (NRM) as the primary outcome after RVI and relapse-related mortality as a competing risk. From 223 eligible patients, pulmonary impairment after RVI was associated with over a 3-fold increase in 2-year NRM (pulmonary impairment, 25.3%; no impairment, 7.4%; univariate subhazard ratio [SHR], 3.9; 95% confidence interval [CI], 1.9 to 8.1; P <.001). After adjusting for age and systemic steroid use, pulmonary impairment after RVI was still associated with increased 2-year NRM (SHR, 3.3 [95% CI, 1.6 to 6.9]; P =.002). After adjustment for race and graft-versus-host disease (GVHD) prophylaxis, chronic GVHD at the time of RVI (odds ratio [OR], 2.8 [95% CI, 1.4 to 5.4]; p =.003) and lymphopenia (OR, 2.2 [95% CI, 1.1 to 4.2]; P =.02) were associated with increased odds of pulmonary impairment, whereas use of nonmyeloablative conditioning was associated with reduced odds of pulmonary impairment (OR,.4 [95% CI,.2 to.8]; P =.006). In allo-HCT recipients with RVIs, pulmonary impairment after RVI is associated with high NRM at 2 years.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Virus Diseases
Respiratory Tract Infections
Transplants
Lung
Mortality
Confidence Intervals
Odds Ratio
Graft vs Host Disease
Transplant Recipients
Paramyxoviridae Infections
Lymphopenia
Respiratory Syncytial Viruses
Respiratory Function Tests
Forced Expiratory Volume
Orthomyxoviridae
Steroids
Morbidity
Recurrence

Keywords

  • Allogeneic hematopoietic cell transplantation
  • Hematologic malignancy
  • Pulmonary function
  • Pulmonary impairment
  • Respiratory viral infection

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Pulmonary Impairment after Respiratory Viral Infections Is Associated with High Mortality in Allogeneic Hematopoietic Cell Transplant Recipients. / Sheshadri, Ajay; Chemaly, Roy F.; Alousi, Amin M.; Shah, Pankil K.; Rondon, Gabriela; Bashoura, Lara; Kmeid, Joumana; Azzi, Jacques; Blanco, David W.; Kaous, Maryam; Dickey, Burton F.; Champlin, Richard E.; Shah, Dimpy P.

In: Biology of Blood and Marrow Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Sheshadri, Ajay ; Chemaly, Roy F. ; Alousi, Amin M. ; Shah, Pankil K. ; Rondon, Gabriela ; Bashoura, Lara ; Kmeid, Joumana ; Azzi, Jacques ; Blanco, David W. ; Kaous, Maryam ; Dickey, Burton F. ; Champlin, Richard E. ; Shah, Dimpy P. / Pulmonary Impairment after Respiratory Viral Infections Is Associated with High Mortality in Allogeneic Hematopoietic Cell Transplant Recipients. In: Biology of Blood and Marrow Transplantation. 2019.
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abstract = "Pulmonary impairment predicts increased mortality in many settings, and respiratory viral infection (RVI) causes considerable morbidity and mortality in allogeneic hematopoietic cell transplant recipients (allo-HCT). We hypothesized that pulmonary impairment after RVI, defined as a decline of forced expiratory volume in 1 second values by ≥10{\%}, may identify allo-HCT recipients at high risk for mortality. We studied all allo-HCT recipients at our institution who had RVI with respiratory syncytial virus, parainfluenza virus, or influenza from 2004 to 2013 and had pre-RVI and post-RVI pulmonary function tests. We used competing risk regression models to identify risk factors for 2-year nonrelapse mortality (NRM) as the primary outcome after RVI and relapse-related mortality as a competing risk. From 223 eligible patients, pulmonary impairment after RVI was associated with over a 3-fold increase in 2-year NRM (pulmonary impairment, 25.3{\%}; no impairment, 7.4{\%}; univariate subhazard ratio [SHR], 3.9; 95{\%} confidence interval [CI], 1.9 to 8.1; P <.001). After adjusting for age and systemic steroid use, pulmonary impairment after RVI was still associated with increased 2-year NRM (SHR, 3.3 [95{\%} CI, 1.6 to 6.9]; P =.002). After adjustment for race and graft-versus-host disease (GVHD) prophylaxis, chronic GVHD at the time of RVI (odds ratio [OR], 2.8 [95{\%} CI, 1.4 to 5.4]; p =.003) and lymphopenia (OR, 2.2 [95{\%} CI, 1.1 to 4.2]; P =.02) were associated with increased odds of pulmonary impairment, whereas use of nonmyeloablative conditioning was associated with reduced odds of pulmonary impairment (OR,.4 [95{\%} CI,.2 to.8]; P =.006). In allo-HCT recipients with RVIs, pulmonary impairment after RVI is associated with high NRM at 2 years.",
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AU - Shah, Pankil K.

AU - Rondon, Gabriela

AU - Bashoura, Lara

AU - Kmeid, Joumana

AU - Azzi, Jacques

AU - Blanco, David W.

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