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Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality

Ottaviano, G; Lucchini, G; Breuer, J; Furtado-Silva, JM; Lazareva, A; Ciocarlie, O; Elfeky, R; ... Chiesa, R; + view all (2020) Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality. British Journal of Haematology , 188 (4) pp. 560-569. 10.1111/bjh.16216. Green open access

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Abstract

Viral respiratory infections (VRIs) contribute to the morbidity and transplant-related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre-HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.

Type: Article
Title: Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/bjh.16216
Publisher version: https://doi.org/10.1111/bjh.16216
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: haematopoietic stem cell transplantation, nasopharyngeal aspirate, transplant-related mortality, viral infections
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10083499
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