Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Viral Infections

Respiratory virus infections after stem cell transplantation: a prospective study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation

Abstract

Community-acquired respiratory virus infections are a cause of mortality after stem cell transplantation (SCT). A prospective study was performed at 37 centers to determine their frequency and importance. Additional cases were also collected to allow the analysis of risk factors for severe infection. Forty episodes were collected in the prospective study and 53 additional episodes through subsequent case collection. The frequency of documented respiratory virus infections was 3.5% among 819 allogeneic and 0.4% among 1154 autologous SCT patients transplanted during the study period. The frequency of lower respiratory tract infections (LRTI) was 2.1% among allogeneic and 0.2% among autologous SCT patients. The mortality within 28 days from diagnosis of a respiratory viral infection was 1.1% among allogeneic SCT while no autologous SCT patient died. The deaths of five patients (0.6%) were directly attributed to a respiratory virus infection (three RSV; two influenza A). On multivariate analysis, lymphocytopenia increased the risk for LRTI (P = 0.008). Lymphocytopenia was also a significant risk factor for LRTI in patients with RSV infections. The overall mortality in RSV infection was 30.4% and the direct RSV-associated mortality was 17.4%. For influenza A virus infection, the corresponding percentages were 23.0% and 15.3%. This prospective study supports the fact that community-acquired respiratory virus infections cause transplant-related mortality after SCT. Bone Marrow Transplantation (2001) 28, 479–484.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ljungman P . Respiratory virus infections in bone marrow transplant recipients: the European perspective Am J Med 1997 102: (Suppl. 3A) 44–48

    Article  CAS  Google Scholar 

  2. Englund J, Sullivan C, Jordan M et al. Respiratory syncytial virus infection in immunocompromised adults Ann Intern Med 1988 109: 203–208

    Article  CAS  Google Scholar 

  3. Harrington RD, Hooton TM, Hackman RC et al. An outbreak of respiratory syncytial virus in a bone marrow transplant center J Infect Dis 1992 165: 987–993

    Article  CAS  Google Scholar 

  4. Whimbey E, Champlin RE, Couch RB et al. Community respiratory virus infections among hospitalized adult bone marrow transplant recipients Clin Infect Dis 1996 22: 778–782

    Article  CAS  Google Scholar 

  5. Whimbey E, Champlin RE, Englund JA et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients Bone Marrow Transplant 1995 16: 393–399

    CAS  Google Scholar 

  6. Ghosh S, Champlin RE, Englund J et al. Respiratory syncytial virus upper respiratory tract illnesses in adult blood and marrow transplant recipients: combination therapy with aerosolized ribavirin and intravenous immunoglobulin Bone Marrow Transplant 2000 25: 751–755

    Article  CAS  Google Scholar 

  7. DeVincenzo JP, Hirsch RL, Fuentes RJ, Top FH Jr . Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation – a compassionate use experience Bone Marrow Transplant 2000 25: 161–165

    Article  CAS  Google Scholar 

  8. Whimbey E, Elting LS, Couch RB et al. Influenza A virus infections among hospitalized adult bone marrow transplant recipients Bone Marrow Transplant 1994 13: 437–440

    CAS  PubMed  Google Scholar 

  9. Lewis V, Champlin R, Englund J et al. Respiratory disease due to parainfluenza virus in adult bone marrow transplant recipients Clin Infect Dis 1996 23: 1033–1037

    Article  CAS  Google Scholar 

  10. Wendt CH, Weisdorf DJ, Jordan MC et al. Parainfluenza virus respiratory infection after bone marrow transplantation New Engl J Med 1992 326: 921–926

    Article  CAS  Google Scholar 

  11. Sparrelid E, Ljungman P, Ekelof-Andstrom E et al. Ribavirin therapy in bone marrow transplant recipients with viral respiratory tract infections Bone Marrow Transplant 1997 19: 905–908

    Article  CAS  Google Scholar 

  12. Ljungman P, Gleaves CA, Meyers JD . Respiratory virus infection in immunocompromised patients Bone Marrow Transplant 1989 4: 35–40

    CAS  Google Scholar 

  13. Ljungman P, De la Camara R, Milpied N et al. A randomized study of valaciclovir as prophylaxis against CMV infection and disease in BMT recipients Bone Marrow Transplant 1999 23: (Suppl. 1) 65

    Article  Google Scholar 

  14. Sparrelid E, Ljungman P, Ekelöf-Andström E et al. Ribavirin therapy in bone marrow transplant recipients with respiratory tract infections Bone Marrow Transplant 1997 19: 905–908

    Article  CAS  Google Scholar 

  15. Lewinsohn D, Bowden R, Matsson D, Crawford S . Phase I study of intravenous ribavirin treatment of respiratory syncytial virus pneumonia after marrow transplantation Antimicrob Agents Chemother 1996 40: 2555–2557

    Article  CAS  Google Scholar 

  16. Engelhard D, Nagler A, Hardan I . Antibody response to a two-dose regimen of influenza vaccine in allogeneic T cell-depleted and autologous BMT recipients Bone Marrow Transplant 1993 11: 1–5

    CAS  PubMed  Google Scholar 

  17. Pauksen K, Linde A, Hammarström V et al. Granulocyte–macrophage colony-stimulating factor as immunomodulating factor together with influenza vaccination in stem cell transplant patients Clin Infect Dis 2000 30: 342–348

    Article  CAS  Google Scholar 

  18. Whimbey E, Couch RB, Englund JA et al. Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia Clin Infect Dis 1995 21: 376–379

    Article  CAS  Google Scholar 

  19. Einsele H, Ehninger G, Steidle M et al. Lymphocytopenia as an unfavorable prognostic factor in patients with cytomegalovirus infection after bone marrow transplantation Blood 1993 82: 1672–1678

    CAS  PubMed  Google Scholar 

  20. Ghosh S, Champlin R, Couch R et al. Rhinovirus infections in myelosuppressed adult blood and marrow transplant recipients Clin Infect Dis 1999 29: 528–532

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful to the investigators who contributed to this study: P Shaw, New Children's Hospital; Sydney; AP Schwarer, Alfred Hospital, Melbourne, Australia; HJ Dornbusch, University Children's Hospital, Graz; C Peters, St Anna Kinderspital, Vienna, Austria; A Ferrant, Cliniques Universitaires St Luc, Brussels; W Feremans, Hopital Erasme, Brussels; D Selleslag, AZ Sint-Jan, Brugge, Belgium; A Vitek, Institute of Hematology and Blood Transfusion, Prague, Czech Republic; L Volin, University Hospital, Helsinki; E Koivunen, Tampere University Hospital, Tampere, Finland; C Cordonnier, Hôpital Henri Mondor, Creteil, France; R Arnold, Universitätsklinikum Charité; W Knauf, Klinikum Benjamin Franklin, Berlin; U Duffner, Universitäts-kinderklinik, Freiburg; W Kruger; University Hospital, Hamburg-Eppendorf; AA Fauser, University Hospital, Idar Oberstein; F Zintl, Friedrich-Schiller Universität, Jena, Germany; A Bosi, University Hospital, Florence; F Patrone, University of Genova, Genova; G Lambertenghi-Deliliers, Ospedale Maggiore, Milan; EP Alessandrino, Policlinico S Matteo, Pavia; P Bavaro, Ospedale Civile, Pescara, Italy; A Dekker, University Hospital, Utrecht, The Netherlands; L Brinch, Rikshospitalet, Oslo; H Holte, Norwegian Radium Hospital, Oslo, Norway; H Mocikova, Roosevelt Hospital, Banská Bystrica, Slovakia; R Martino, Hospital Santa Creu i Sant Pau, Barcelona; R De La Camara, Hospital de la Princesa, Madrid; D Caballero, University Hospital, Salamanca, Spain; P Ljungman, Huddinge University Hospital, Stockholm; M Brune, Sahlgren's Hospital, Gothenburg; K Pauksen, K Carlsson, Uppsala University Hospital, Uppsala; U Tidefelt, Örebro Hospital, Örebro, Sweden; D Milligan, Birmingham Heartlands Hospital, Birmingham; D Spence, HCI International Medical Center, Clydebank; A Parker, Glasgow Royal Infirmary, Glasgow; S Schey, Guys Hospital, London; KN Ward, Hammersmith Hospital, London; B Crooks, Newcastle General Hospital; G Jackson, R Skinner, Royal Victoria Infirmary, Newcastle upon Tyne; N Russell, Nottingham; P Lorigan, Weston Park Hospital, Sheffield, UK.

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ljungman, P., Ward, K., Crooks, B. et al. Respiratory virus infections after stem cell transplantation: a prospective study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 28, 479–484 (2001). https://doi.org/10.1038/sj.bmt.1703139

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1703139

Keywords

This article is cited by

Search

Quick links