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Incidence and impact of community respiratory viral infections in post‐transplant cyclophosphamide‐based graft‐ versus ‐host disease prophylaxis and haploidentical stem cell transplantation
Author(s) -
Mulroney Carolyn M.,
Abid Muhammad Bilal,
Bashey Asad,
Chemaly Roy F.,
Ciurea Stefan O.,
Chen Min,
Dandoy Christopher E.,
Diaz Perez Miguel A.,
Friend Brian D.,
Fuchs Ephraim,
Ganguly Siddhartha,
Goldsmith Scott R.,
Kanakry Christopher G.,
Kim Soyoung,
Komanduri Krishna V.,
Krem Maxwell M.,
Lazarus Hillard M.,
Ljungman Per,
Maziarz Richard,
Nishihori Taiga,
Patel Sagar S.,
Perales MiguelAngel,
Romee Rizwan,
Singh Anurag K.,
Reid Wingard John,
Yared Jean,
Riches Marcie,
Taplitz Randy
Publication year - 2021
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.17563
Subject(s) - medicine , hazard ratio , incidence (geometry) , graft versus host disease , transplantation , immunology , cumulative incidence , cyclophosphamide , hematopoietic stem cell transplantation , confidence interval , chemotherapy , physics , optics
Summary Community respiratory viral infections (CRVIs) are associated with pulmonary function impairment, alloimmune lung syndromes and inferior survival in human leucocyte antigen (HLA)‐matched allogeneic haematopoietic stem cell transplant (HCT) recipients. Although the incidence of viral infections in HLA‐haploidentical HCT recipients who receive post‐transplant cyclophosphamide (PTCy)‐based graft‐ versus ‐host disease (GVHD) prophylaxis is reportedly increased, there are insufficient data describing the incidence of CRVIs and the impact of donor source and PTCy on transplant outcomes. Analysing patients receiving their first HCT between 2012 and 2017 for acute myeloid leukaemia, acute lymphoblastic leukaemia and myelodysplastic syndromes, we describe comparative outcomes between matched sibling transplants receiving either calcineurin‐based GVHD prophylaxis (SibCNI, N = 1605) or PTCy (SibCy, N = 403), and related haploidentical transplants receiving PTCy (HaploCy, N = 757). The incidence of CRVIs was higher for patients receiving PTCy, regardless of donor type. Patients in the HaploCy cohort who developed a CRVI by day +180 had both a higher risk of treatment‐related mortality [hazard ratio (HR) 2⋅14, 99% confidence interval (CI) 1⋅13–4⋅07; P = 0⋅002] and inferior 2‐year overall survival (HR 1⋅65, 99% CI 1⋅11–2⋅43; P = 0⋅001) compared to SibCNI with no CRVI. This finding justifies further research into long‐term antiviral immune recovery, as well as development of preventive and treatment strategies to improve long‐term outcomes in such patients.