Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy

Ariadna Pérez; Juan Montoro; Pedro Chorão; Dolores Gómez; Manuel Guerreiro; Estela Giménez; Marta Villalba; Jaime Sanz; Rafael Hernani; Juan Carlos Hernández-Boluda; Ignacio Lorenzo; David Navarro; Carlos Solano; Per Ljungman; José Luis Piñana

doi:10.1007/s15010-024-02213-0

Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy

Infection. 2024 Apr 24. doi: 10.1007/s15010-024-02213-0. Online ahead of print.

Authors

Ariadna Pérez¹, Juan Montoro², Pedro Chorão², Dolores Gómez³, Manuel Guerreiro², Estela Giménez⁴, Marta Villalba², Jaime Sanz², Rafael Hernani¹, Juan Carlos Hernández-Boluda^{1

5}, Ignacio Lorenzo², David Navarro^{4

6}, Carlos Solano^{1

5}, Per Ljungman^{7

8}, José Luis Piñana^{9

10}

Affiliations

¹ Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain.
² Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
³ Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
⁴ Microbiology Service, Hospital Clínico Universitario, Valencia, Spain.
⁵ Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.
⁶ Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain.
⁷ Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Medicine, Karolinska Institutet (KI), Huddinge, Sweden.
⁹ Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain. jlpinana@gmail.com.
¹⁰ Division of Clinical Hematology, Hospital Clinico Universitario de Valencia, Avda. Blasco Ibañez, N 17, 46010, Valencia, Spain. jlpinana@gmail.com.

PMID: 38653955
DOI: 10.1007/s15010-024-02213-0

Abstract

Background: This retrospective study focused on analyzing community-acquired respiratory virus (CARV) infections, in particular human parainfluenza virus (hPIV) after allogeneic stem cell transplant (allo-SCT) in adults recipients. It aimed to assess the impact of ribavirin treatment, clinical characteristics, and risk factors associated with lower respiratory tract disease (LRTD) progression and all-cause mortality.

Patients and methods: The study included 230 allo-SCT recipients diagnosed with hPIV between December 2013 and June 2023. Risk factors for the development of LRTD, disease severity, and mortality were analyzed. Ribavirin treatment was administered at physician discretion in 61 out of 230 cases (27%).

Results: Risk factors for LRTD progression in multivariate analysis were corticosteroids > 30 mg/day (Odds ratio (OR) 3.5, 95% Confidence Interval (C.I.) 1.3-9.4, p = 0.013), fever at the time of hPIV detection (OR 3.89, 95% C.I. 1.84-8.2, p < 0.001), and absolute lymphocyte count (ALC) < 0.2 × 10⁹/L (OR 4.1, 95% C.I. 1.42-11.9, p = 0.009). In addition, the study found that ribavirin therapy significantly reduced progression to LRTD [OR 0.19, 95% C.I. 0.05-0.75, p = 0.018]. Co-infections (OR 5.7, 95% C.I. 1.4-23.5, p = 0.015) and ALC < 0.2 × 10⁹/L (OR 17.7, 95% C.I. 3.6-87.1, p < 0.001) were independently associated with higher day + 100 after hPIV detection all-cause mortality. There were no significant differences in all-cause mortality and infectious mortality at day + 100 between the treated and untreated groups.

Conclusion: ALC, corticosteroids, and fever increased the risk for progression to LRTD while ribavirin decreased the risk. However, mortality was associated with ALC and co-infections. This study supports further research of ribavirin therapy for hPIV in the allo-HSCT setting.

Keywords: Allogeneic hematopoietic stem cell transplantation; Community acquire respiratory virus; Human parainfluenza virus; Immunodeficiency scoring index; Respiratory viral infection; Ribavirin.