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Blood, 1 August 2001, Vol. 98, No. 3, pp. 573-578
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Parainfluenza virus infections after hematopoietic stem cell
transplantation: risk factors, response to antiviral therapy, and
effect on transplant outcome
W. Garrett Nichols,
Lawrence Corey,
Ted Gooley,
Chris Davis, and
Michael Boeckh
From the Fred Hutchinson Cancer Research Center and the
University of Washington, Seattle, WA.
Parainfluenza virus (PIV) infections may be significant causes of
morbidity and mortality in patients undergoing stem cell transplantation, but data regarding their impact on transplant-related mortality is limited. This study sought to determine the risk factors
of PIV acquisition and progression to lower respiratory tract
infection, their impact on transplant-related mortality, and the
effectiveness of antiviral therapy. A total of 3577 recipients of
hematopoietic stem cell transplantation (HSCT) between 1990 and 1999 were studied. PIV infections occurred in 253 patients (7.1%); 78% of
these infections were community acquired. Multivariable analysis
identified the receipt of an unrelated transplant as the only risk
factor for PIV acquisition; the dose of corticosteroids at the time of
PIV infection acquisition was the primary factor associated with the
development of PIV-3 pneumonia, both among allogeneic and autologous
HSCT recipients. Both PIV-3 upper respiratory infection and pneumonia
were associated with overall mortality. Pulmonary copathogens were
isolated from 29 patients (53%) with pneumonia. Mortality was highly
influenced by the presence of copathogens and the need for mechanical
ventilation. Aerosolized ribavirin with or without intravenous
immunoglobulin did not appear to alter mortality from PIV-3 pneumonia,
nor did such therapy decrease the duration of viral shedding from the
nasopharynx among patients with pneumonia. Corticosteroid
administration thus drives the development of PIV pneumonia in a
dose-dependent fashion, even among autologous HSCT recipients.
Both upper and lower tract PIV infections are predictors of mortality
after HSCT. Currently available antiviral therapy appears to be
inadequate in reducing viral shedding or mortality once pneumonia is established.
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