Background: There is growing evidence that community acquired respiratory virus (CARV) increase the risk of pulmonary invasive fungal disease (IFD) in recipients of allogeneic hematopoietic stem cell transplantation (alloHSCT). To date, there is a lack of knowledge regarding the rate of IFD, risk factors (RFs) as well as the most critical period for the development of a later IFD after CARV infections in allo-HSCT recipients. Methods: In this prospective observational study, we retrospectively analyzed the effect of CARV on the development of a later IFD in a consecutive cohort of 287 allo-HSCT adult recipients who developed 597 CARV infectious episodes from December 2013 to December 2018. Respiratory virus in upper and/or lower respiratory tract specimens were tested using multiplex PCR panel assays. Results: Overall, 29 out of 287 allo-HSCT recipients (10%) developed IFD within 2 months after a CARV episode at median of 21 days (range 0-158 days) from the day of CARV detection. All the IFDs involved the lungs and in 28 cases (97%) the diagnostic was IA accomplishing criteria of probable (n= 26) or proven (n=2). Of note, 26 out of 29 IFD (91%) occurred within the first year after transplantation. The overall rate of IFD after CARV episodes was 5% whereas this rate was higher in recipients developing CARV during the first year of transplant (7%). IFD was diagnosed in 25 out of 203 with CARV lower respiratory tract disease (LRTD) episodes (12%) compared to 4 out of 394 CARV upper respiratory tract disease (URTD) (1%) (p= 0.0001). Twenty-three out of 133 CARV episodes involving the LRTD during the first year after transplant (17%) developed IFD. We did not found differences in IFD rates according to the type of CARV identified. Multivariate analysis identified 4 RFs for IFD: the use of ATG as a part of conditioning [odds ratio (OR) 2.7, 95% confidence interval (C.I.) 1.2-3.4, p= 0.01], CARV LRTD (OR 11.8, 95% C.I. 3.8-36, p= 0.0001), CARV infection during the first year of transplant (OR 5.9, 95% C.I. 1.7-20.6, p= 0.001) and voriconazol prophylaxis during CARV (OR 4.2, 95% C.I. 1.1-115.6, p= 0.03). Conclusions: We provide evidence that IFD after CARV infection. Allo-HSCT recipients developing a CARV LRTD during the first year after transplant may benefit from an adequate antifungal prophylaxis and a close monitoring for the development of a later IFD. Disclosure: Jose Luis Piñana has received both, advisory for preclinical/clinical research and financial support to assist to the Spanish society of hematology annual meeting 2018 from MSD.
Full conference title:
- EBMT 45th (2019)