title: Significant Transplantation-Related Mortality from Respiratory Virus Infections within the First One Hundred Days in Children after Hematopoietic Stem Cell Transplantation.
abstract: Respiratory viral infections (RVI) are important in hematopoietic stem cell transplantations (HSCT) and knowledge regarding incidence, morbidity, mortality, and long-term pulmonary complications is limited. We report a study to evaluate incidence and outcomes, both short and long-term, of RVI in children receiving HSCT. Between January 2000 and December 2012, 844 patients underwent hematopoietic stem cell transplantation (HSCT) at the Hospital for Sick Children: 491 were allogeneic and 353 were autologous. When screening for causes of death in the first year after HSCT in the 844 patients, we found that RVI as a cause of death was only evident in the first 100 days after HSCT. Fifty-four (6.5%) patients were found to have an RVI within the first 100 days after HSCT (allogeneic = 32, autologous = 22). Upper and lower respiratory tract infections were documented in 31 (57%) and 23 (43%) patients, respectively. Viruses were parainfluenza (35%), respiratory syncytial virus (28%), influenza (22%), adenovirus (7%), human metapneumovirus (4%), coronavirus (2%), and rhinovirus (2%). Three patients relapsed with their primary disease before day 100 and were excluded. The overall mortality for the remaining 51 patients was 10% (allogeneic = 4, autologous = 1). All 5 deaths were directly attributable to RVI and all 5 deaths occurred in patients with a lower respiratory tract infection. The remaining patients were followed for a median of 4.3 years (range, 1.4 to 11.8) and no chronic pulmonary complications were observed. A clear seasonal pattern for contracting RVI was evident with 65% of total RVI occurring between October and March (35 of 427 versus 19 of 417, P = .03). Given the significant mortality from RVI and the challenges in preventing them, choosing the time to start HSCT, whenever possible, may help prevent RVI and improve outcomes.
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada. Electronic address: sakara4695@yahoo.com.
authors.forename: Sakara
authors.initials: S
authors.lastname: Hutspardol
authors.affiliation: Division of Haematology/Oncology/SCT, King Saud bin Abdulaziz University for Health Sciences, King Abdullah Specialized Children's Hospital Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Essa
authors.affiliation: Division of Microbiology, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Richardson
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Tal
authors.initials: T
authors.lastname: Schechter
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Joerg
authors.initials: J
authors.lastname: Krueger
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Hisaki
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: R Maarten
authors.initials: RM
authors.lastname: Egeler
authors.affiliation: Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Gassas
mesh_terms: D000293:Adolescent; D064591:Allografts; D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004780:Environment, Controlled; D064147:Febrile Neutropenia / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D030342:Genetic Diseases, Inborn / Q000628:therapy; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D051359:Lymphohistiocytosis, Hemophagocytic / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000628:therapy; D018529:Nutritional Support; D011024:Pneumonia, Viral / Q000401:mortality / Q000628:therapy / Q000821:virology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy / Q000821:virology; D012189:Retrospective Studies; D012306:Risk; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014777:Virus Diseases / Q000401:mortality* / Q000821:virology
chemical_list: D000998:Antiviral Agents
keywords: Children; Hematopoietic stem cell transplantation; Mortality; Respiratory virus infection