TY - JOUR
T1 - Pulmonary Impairment after Respiratory Viral Infections Is Associated with High Mortality in Allogeneic Hematopoietic Cell Transplant Recipients
AU - Sheshadri, Ajay
AU - Chemaly, Roy F.
AU - Alousi, Amin M.
AU - Shah, Pankil K.
AU - Rondon, Gabriela
AU - Bashoura, Lara
AU - Kmeid, Joumana
AU - Azzi, Jacques
AU - Blanco, David W.
AU - Kaous, Maryam
AU - Dickey, Burton F.
AU - Champlin, Richard E.
AU - Shah, Dimpy P.
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2019/4
Y1 - 2019/4
N2 - 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 2years.
AB - 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 2years.
KW - Allogeneic hematopoietic cell transplantation
KW - Hematologic malignancy
KW - Pulmonary function
KW - Pulmonary impairment
KW - Respiratory viral infection
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U2 - 10.1016/j.bbmt.2018.11.022
DO - 10.1016/j.bbmt.2018.11.022
M3 - Article
C2 - 30521974
AN - SCOPUS:85059959131
SN - 1083-8791
VL - 25
SP - 800
EP - 809
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 4
ER -