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J Infect Dis. 2014 Apr 15;209(8):1195-204. doi: 10.1093/infdis/jit832. Epub 2013 Dec 23.

Respiratory syncytial virus in hematopoietic cell transplant recipients: factors determining progression to lower respiratory tract disease.

Author information

1
Fred Hutchinson Cancer Research Center, Seattle, Washington.

Abstract

BACKGROUND:

Respiratory syncytial virus (RSV) lower respiratory tract disease (LRD) is a life-threatening complication in hematopoietic cell transplant (HCT) recipients. Lymphopenia has been associated with an increased risk of progression from upper respiratory tract infection (URI) to LRD.

METHODS:

This study retrospectively analyzed the significance of lymphocyte engraftment dynamics, lung function, smoking history, corticosteroids, antiviral treatment, viral subtypes, and RSV-specific neutralizing antibodies for the progression to LRD in 181 HCT recipients with RSV URI.

RESULTS:

In multivariable models, smoking history, conditioning with high-dose total body irradiation, and an absolute lymphocyte count (ALC) ≤100/mm(3) at the time of URI onset were significantly associated with disease progression. No progression occurred in patients with ALCs of >1000/mm(3) at URI onset. Lymphocyte engraftment dynamics were similar in progressors and nonprogressors. Pre- and posttransplant donor and posttransplant recipient RSV subtype-specific neutralizing antibody levels, RSV viral subtypes, and corticosteroids also were not significantly associated with LRD progression.

CONCLUSIONS:

Host and transplant related factors appear to determine the risk of progression to LRD more than viral factors. Dysfunctional cell-mediated immunity appears to be important in the pathogenesis of progressive RSV disease after HCT. A characterization of RSV-specific T-cell immunity is warranted.

KEYWORDS:

Hematopoietic cell transplantation; Respiratory syncytial virus; Respiratory tract disease; Respiratory virus

PMID:
24368837
PMCID:
PMC3969549
DOI:
10.1093/infdis/jit832
[Indexed for MEDLINE]
Free PMC Article
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