Role of Respiratory Viral Infections in Airflow Obstruction After Hematopoietic Cell Transplantation
Sapna A. Pardasani, Ali Y. Suliman, Jose A. Ferrolino, Ronald H. Dallas, Megan Peterson, Pamela Merritt, Amanda Cole, Amber Davis, Ashleigh Gowen, Kim J. Allison, Randall T. Hayden, Ying Li, Dinesh Keerthi, Saumini Srinivasan, Gabriela M. Maron, Brandon M. Trilplett, Diego R. HijanoABSTRACT
Background
Respiratory viral infections (RVIs) in allogeneic hematopoietic cell transplant (allo‐HCT) recipients can cause airflow obstruction (AFO). Despite this risk, the impact of community‐acquired RVI on PFTs in pediatric patients after allo‐HCT remains unclear.
Objective
The study determines the role of RVI in the development of AFO post‐transplant among survivors of allo‐HCT.
Study Design
This retrospective study analyzed St. Jude patients undergoing allo‐HCT between 2003–2020. AFO was defined by z ‐scores and forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio expressed as lower limit of normal (LLN). Baseline parameters were obtained before allo‐HCT, and Year 1 parameters within 425 days post allo‐HCT. Spirometry measures were calculated using the global lung function Initiative (GLI) calculator. Bivariate and multivariate logistic regression identified risk factors for AFO following allo‐HCT.
Results
A total of 397 patients were included, with a median age of 12.7 years. RVI occurred in 13% of patients within the first 100 days after transplantation. AFO developed in 12% of patients. Among those with AFO, 68% had a baseline FEV1/FVC ratio above the LLN, and 11% had a history of lower respiratory tract infection (LRTI) ( p < 0.05). The median time from transplant to RVI was shorter in patients with AFO (12 vs. 34 days). A baseline LLN value was a significant predictor of AFO. However, after adjusting for known covariates, RVI was not independently associated with AFO risk.
Conclusion
RVIs within 100 days of allo‐HCT did not significantly affect AFO following transplant in pediatric patients.