title: Clinical outcomes associated with respiratory virus detection before allogeneic hematopoietic stem cell transplant.
abstract: BACKGROUND
  The management of respiratory virus infections prior to hematopoietic cell transplant (HCT) is difficult. We examined whether respiratory virus detection before HCT influenced the requirement for bronchoscopy, hospitalization, and overall survival following HCT.
  
  
  METHODS
  Pre-HCT and weekly post-HCT nasal washes were collected through day 100 from patients with and without symptoms. Samples were tested by multiplex polymerase chain reaction for respiratory syncytial virus, parainfluenza viruses 1-4, influenza A and B, human metapneumovirus, adenovirus, and human rhinoviruses, coronaviruses, and bocavirus.
  
  
  RESULTS
  Of 458 patients, 116 (25%) had respiratory viruses detected pre-HCT. Overall, patients with viruses detected pre-HCT had fewer days alive and out of the hospital and lower survival at day 100 (adjusted hazard ratio [aHR], 2.4; 95% confidence interval [CI], 1.3-4.5; P = .007) than patients with negative samples; this risk was also present with rhinovirus alone (aHR for mortality, 2.6; 95% CI, 1.2-5.5; P = .01). No difference in bronchoscopy incidence was seen in patients with and without respiratory viruses (aHR, 1.3; 95% CI, .8-2.0; P = .32). In symptomatic patients, those with respiratory viruses detected had increased overall mortality compared with patients without viruses detected (unadjusted HR, 3.5; 95% CI, 1.0-12.1; P = .05); among asymptomatic patients, detection of respiratory viruses was not associated with increased mortality.
  
  
  CONCLUSIONS
  These data support routine testing for respiratory viruses among symptomatic patients before HCT, and delay of transplant with virus detection when feasible, even for detection of rhinovirus alone. Further study is needed to address whether asymptomatic patients should undergo screening for respiratory virus detection before HCT.
authors.affiliation: Fred Hutchinson Cancer Research Center Seattle Children's Hospital University of Washington, Seattle.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Campbell
authors.affiliation: Fred Hutchinson Cancer Research Center.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.affiliation: Fred Hutchinson Cancer Research Center Seattle Children's Hospital University of Washington, Seattle.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.affiliation: Fred Hutchinson Cancer Research Center.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Farney
authors.affiliation: Fred Hutchinson Cancer Research Center Seattle Children's Hospital.
authors.forename: Elisa L
authors.initials: EL
authors.lastname: Minerich
authors.affiliation: Fred Hutchinson Cancer Research Center University of Washington, Seattle.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Fred Hutchinson Cancer Research Center University of Washington, Seattle.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.affiliation: Fred Hutchinson Cancer Research Center University of Washington, Seattle.
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D017934:Coronavirus / Q000302:isolation & purification; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D017817:Nasal Lavage Fluid / Q000821:virology*; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000821:virology*; D012229:Rhinovirus / Q000302:isolation & purification; D013997:Time Factors; D014777:Virus Diseases / Q000175:diagnosis* / Q000821:virology; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: hematopoietic cell transplant; pneumonia; respiratory virus infection
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