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

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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.

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Data availability statement

Data available upon formal request by email to Jose Luis Piñana.

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Funding

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Author information

Authors and Affiliations

  1. Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain

    Ariadna Pérez, Rafael Hernani, Juan Carlos Hernández-Boluda, Carlos Solano & José Luis Piñana

  2. Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    Juan Montoro, Pedro Chorão, Manuel Guerreiro, Marta Villalba, Jaime Sanz & Ignacio Lorenzo

  3. Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    Dolores Gómez

  4. Microbiology Service, Hospital Clínico Universitario, Valencia, Spain

    Estela Giménez & David Navarro

  5. Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain

    David Navarro

  6. Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain

    Juan Carlos Hernández-Boluda & Carlos Solano

  7. Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden

    Per Ljungman

  8. Department of Medicine, Karolinska Institutet (KI), Huddinge, Sweden

    Per Ljungman

  9. Division of Clinical Hematology, Hospital Clinico Universitario de Valencia, Avda. Blasco Ibañez, N 17, 46010, Valencia, Spain

    José Luis Piñana

Authors
  1. Ariadna Pérez
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  15. José Luis Piñana
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Contributions

Authors responsible for the conception and the design of the study: Jose Luis Piñana and Ariadna Perez. Authors who performed the data analysis and generated the tables and figures: Jose Luis Piñana and Per Ljungman. Authors responsible for patient recruitment: José Luis Piñana, Juan Montoro, Ariadna Pérez, Pedro Chorão, Dolores Gómez, Manuel Guerreiro, Marta Villalba, and Rafael Hernani. Authors responsible for writing the manuscript: Jose Luis Piñana, Ariadna Perez, Per Ljungman, David Navarro, Dolores Gomez, Estela Gimenez and Carlos Solano were responsible for writing and supervising the writing of the manuscript. All co-authors were responsible for reviewing the analysis interpretation, suggesting modifications to the text, critically reviewing the manuscript, and for the final approval of the manuscript.

Corresponding author

Correspondence to José Luis Piñana.

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Conflict of interest

The author(s) declare that they have no conflicts of interest and have no funding resources to declare for this study.

Ethics approval statement

The local research ethics committee of the Hospital Clínico Universitario of Valencia approved the registry and study protocol (reference code 2019/351).

Patient consent statement

All patients included in this registry gave their signed informed consent in accordance with the declaration of Helsinki.

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Pérez, A., Montoro, J., Chorão, P. et al. Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy. Infection (2024). https://doi.org/10.1007/s15010-024-02213-0

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