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Infection with a respiratory virus before hematopoietic cell transplantation is associated with alloimmune-mediated lung syndromes.
Journal of Allergy and Clinical Immunology ( IF 11.4 ) Pub Date : 2017-07-15 , DOI: 10.1016/j.jaci.2017.03.055 Birgitta Versluys 1 , Marc Bierings 1 , Jean Luc Murk 2 , Tom Wolfs 3 , Caroline Lindemans 1 , Kors Vd Ent 4 , Jaap Jan Boelens 5
Journal of Allergy and Clinical Immunology ( IF 11.4 ) Pub Date : 2017-07-15 , DOI: 10.1016/j.jaci.2017.03.055 Birgitta Versluys 1 , Marc Bierings 1 , Jean Luc Murk 2 , Tom Wolfs 3 , Caroline Lindemans 1 , Kors Vd Ent 4 , Jaap Jan Boelens 5
Affiliation
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BACKGROUND
Alloimmune-mediated lung syndromes (allo-LSs) are life-threatening complications after hematopoietic cell transplantation (HCT). Respiratory virus (RV) has been suggested to play a role in the pathogenesis.
OBJECTIVE
We studied the relation between RV DNA/RNA detection in the upper/lower airways before HCT and the occurrence of allo-LSs.
METHODS
We retrospectively analyzed all HCT recipients between 2004 and 2014, in whom real-time PCR for RV was performed in nasopharyngeal aspirates (NPAs) and bronchoalveolar lavage (BAL) fluid before HCT. The main outcome of interest was the presence of an allo-LS, which was defined as idiopathic pneumonia syndrome or bronchiolitis obliterans syndrome. Other outcomes were overall survival and treatment-related mortality. We used Cox proportional hazard models, logistic regression models, and Fine-Gray competing risk regression for analyses.
RESULTS
One hundred seventy-nine children (median age, 6.8 years) were included. RVs were found in 61% (41% in BAL fluid/NPAs and 20% in NPAs only). Rhinovirus was the most frequently detected RV (42%). Allo-LSs occurred in 13%. RV positivity in BAL fluid was a predictor for allo-LSs (hazard ratio, 3.8; 95% CI, 1.4-10.7; P = .01), whereas RV positivity in NPAs only was not. No other predictors were found. Grade II to IV acute graft-versus-host disease related to steroid treatment shows a trend toward a protective effect (odds ratio, 0.16; 95% CI, 0.0-1.3; P = .08). Allo-LSs significantly increased treatment-related mortality (52% ± 10% in allo-LSs and 20% ± 4% in non-allo-LSs, P = .007).
CONCLUSIONS
These results show that pre-HCT BAL fluid RV positivity was a predictor for allo-LSs. Screening for RVs before HCT might identify patients at risk for allo-LSs. This could have implications for prevention and treatment and might subsequently influence the outcomes of HCT.
中文翻译：
造血细胞移植前感染呼吸道病毒与同种免疫介导的肺综合征有关。
背景技术同种免疫介导的肺综合征（allo-LSs）是造血细胞移植（HCT）后威胁生命的并发症。有人认为呼吸道病毒（RV）在发病机理中起作用。目的研究HCT前上/下呼吸道RV DNA / RNA检测与异基因LSs发生的关系。方法我们回顾性分析了2004年至2014年间所有HCT接受者，其中在HCT之前在鼻咽抽吸物（NPA）和支气管肺泡灌洗液（BAL）中进行了RV实时PCR。感兴趣的主要结果是存在allo-LS，其被定义为特发性肺炎综合征或闭塞性细支气管炎综合征。其他结果是总体生存率和与治疗相关的死亡率。我们使用了Cox比例风险模型，逻辑回归模型，和Fine-Gray竞争风险回归进行分析。结果纳入179名儿童（中位年龄为6.8岁）。RV占61％（仅BAL液/ NPA中占41％，NPA中占20％）。鼻病毒是最常检测到的RV（42％）。异体LS发生率为13％。BAL液中的RV阳性是异源性LS的预测指标（危险比，3.8； 95％CI，1.4-10.7； P = 0.01），而仅NPA中的RV阳性不是。找不到其他预测变量。与类固醇治疗有关的II至IV级急性移植物抗宿主病显示出具有保护作用的趋势（赔率，0.16； 95％CI，0.0-1.3； P = 0.08）。Allo-LSs显着增加了与治疗相关的死亡率（allo-LSs为52％±10％，非allo-LSs为20％±4％，P = .007）。结论这些结果表明，HCT前BAL液RV阳性是allo-LSs的预测指标。在HCT之前筛查RV可能会发现有异基因低危患者的风险。这可能会对预防和治疗产生影响，并可能随后影响HCT的结果。
更新日期：2017-07-15
中文翻译：
造血细胞移植前感染呼吸道病毒与同种免疫介导的肺综合征有关。
背景技术同种免疫介导的肺综合征（allo-LSs）是造血细胞移植（HCT）后威胁生命的并发症。有人认为呼吸道病毒（RV）在发病机理中起作用。目的研究HCT前上/下呼吸道RV DNA / RNA检测与异基因LSs发生的关系。方法我们回顾性分析了2004年至2014年间所有HCT接受者，其中在HCT之前在鼻咽抽吸物（NPA）和支气管肺泡灌洗液（BAL）中进行了RV实时PCR。感兴趣的主要结果是存在allo-LS，其被定义为特发性肺炎综合征或闭塞性细支气管炎综合征。其他结果是总体生存率和与治疗相关的死亡率。我们使用了Cox比例风险模型，逻辑回归模型，和Fine-Gray竞争风险回归进行分析。结果纳入179名儿童（中位年龄为6.8岁）。RV占61％（仅BAL液/ NPA中占41％，NPA中占20％）。鼻病毒是最常检测到的RV（42％）。异体LS发生率为13％。BAL液中的RV阳性是异源性LS的预测指标（危险比，3.8； 95％CI，1.4-10.7； P = 0.01），而仅NPA中的RV阳性不是。找不到其他预测变量。与类固醇治疗有关的II至IV级急性移植物抗宿主病显示出具有保护作用的趋势（赔率，0.16； 95％CI，0.0-1.3； P = 0.08）。Allo-LSs显着增加了与治疗相关的死亡率（allo-LSs为52％±10％，非allo-LSs为20％±4％，P = .007）。结论这些结果表明，HCT前BAL液RV阳性是allo-LSs的预测指标。在HCT之前筛查RV可能会发现有异基因低危患者的风险。这可能会对预防和治疗产生影响，并可能随后影响HCT的结果。
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