title: Mortality rates of human metapneumovirus and respiratory syncytial virus lower respiratory tract infections in hematopoietic cell transplantation recipients.
abstract: Human metapneumovirus (HMPV), a common respiratory virus, can cause severe disease in pre- and post-hematopoietic cell transplantation (HCT) recipients. We conducted a retrospective cohort analysis in HCT patients with HMPV (n = 23) or respiratory syncytial virus (n = 23) detected in bronchoalveolar lavage samples by reverse transcription PCR between 2006 and 2011 to determine disease characteristics and factors associated with outcome. Mortality rates at 100 days were 43% for both HMPV and respiratory syncytial virus lower respiratory tract disease. Steroid therapy, oxygen requirement >2 L or mechanical ventilation, and bone marrow as cell source were significant risk factors for overall and virus-related mortality in multivariable models, whereas the virus type was not. The presence of centrilobular/nodular radiographic infiltrates was a possible protective factor for mechanical ventilation. Thus, HMPV lower respiratory tract disease is associated with high mortality in HCT recipients. Earlier detection in combination with new antiviral therapy is needed to reduce mortality among HCT recipients.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Renaud
authors.forename: Hu
authors.initials: H
authors.lastname: Xie
authors.forename: Sachiko
authors.initials: S
authors.lastname: Seo
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.forename: Anne
authors.initials: A
authors.lastname: Cent
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification*; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000276:immunology / Q000401:mortality* / Q000821:virology; D011024:Pneumonia, Viral / Q000276:immunology / Q000401:mortality* / Q000821:virology; D018357:Respiratory Syncytial Virus Infections / Q000276:immunology / Q000401:mortality* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents
keywords: Hematopoietic stem cell transplant; Human metapneumovirus; Immunocompromised; Pneumonia; Respiratory syncytial virus