Birgitta Versluijs

109 Respiratory virus infection pre-HCT and alloimmune-mediated lung syndromes 7 Abstract Background  Alloimmune-mediated lung syndromes (allo- LSs) are life-threatening complications after hematopoietic cell transplantation (HCT). Respiratory virus (RV) has been suggested to play a role in the pathogenesis. Objective  We studied the relation between RV DNA/RNA detection in the upper/lower airways before HCT and the oc- currence of allo-LSs. Methods  We retrospectively analyzed all HCT recipients between 2004 and 2014, in whom real-time PCR for RV was performed in nasopharyngeal aspirates (NPAs) and bron- choalveolar lavage (BAL) fluid before HCT. The main out- come of interest was the presence of an allo-LS, which was defined as idiopathic pneumonia syndrome or bronchiolitis obliterans syndrome. Other outcomes were overall survival and treatment-related mortality. We used Cox proportional hazard models, logistic regression models, and Fine-Gray competing risk regression for analyses. Results  One hundred seventy-nine children (median age, 6.8 years) were included.RVs were found in 61% (41% in BAL fluid/NPAs and 20% in NPAs only). Rhinovirus was the most frequently detected RV (42%). Allo-LSs occurred in 13%. RV positivity in BAL fluid was a predictor for allo-LSs (hazard ratio, 3.8; 95%CI, 1.4-10.7; P = .01), whereas RV positivity in NPAs only was not. No other predictors were found. Grade II to IV acute graft-versus-host disease related to steroid treatment shows a trend toward a protective effect (odds ra- tio, 0.16; 95% CI, 0.0-1.3;P = .08). Allo-LSs significantly incre- ased treatment-related mortality (52% ± 10% in allo-LSs and 20% ± 4% in non–allo-LSs, P = .007). Conclusions  These results show that pre-HCT BAL fluid RV positivity was a predictor for allo-LSs. Screening for RVs befo- re HCT might identify patients at risk for allo-LSs. This could have implications for prevention and treatment and might subsequently influence the outcomes of HCT. Blood and Marrow Transplantation Program, Department of Pediatrics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands A.B. Versluys M.B. Bierings C.A. Lindemans J.J. Boelens Department of Virology and Microbiology, UMCU, Utrecht, The Netherlands J.L. Murk Department of Paedia- tric Infectious Diseases, UMCU, Utrecht, The Netherlands T.F.W. Wolfs Department of Paediatric Pulmonology, UMCU, Utrecht, The Netherlands C.K. van der Ent U-DANCE Laboratory of Translational Immuno- logy, UMCU, Utrecht, The Netherlands J.J. Boelens