title: Respiratory syncytial virus in hematopoietic cell transplant recipients: factors determining progression to lower respiratory tract disease.
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.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Yae-Jean
authors.initials: YJ
authors.lastname: Kim
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: Alpana
authors.initials: A
authors.lastname: Waghmare
authors.forename: Edward E
authors.initials: EE
authors.lastname: Walsh
authors.forename: Ann R
authors.initials: AR
authors.lastname: Falsey
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.forename: Anne
authors.initials: A
authors.lastname: Cent
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007223:Infant; D008297:Male; D008875:Middle Aged; D009500:Neutralization Tests; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000472:pathogenicity*; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids
keywords: Hematopoietic cell transplantation; Respiratory syncytial virus; Respiratory tract disease; Respiratory virus