Background Information: Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) are at higher risk for developing community respiratory viral infections (CRV) due to their immunocompromised state throughout therapy and for the remainder of their lives. Current pre-transplantation infection prevention guidelines recommend a respiratory viral panel PCR (RVP) to test for infection when patients are symptomatic, but the efficacy of RVP surveillance both pre- and post-transplantation is an active area of research. We aimed to assess the efficacy of pre- and post-transplantation RVP surveillance with the goal of preventing adverse health outcomes due to CRVs in allogeneic HSCT patients.
Methods: Data was obtained through the UCLA Stem Cell Transplant Database and electronic medical records of patients who received an allogeneic hematopoietic stem cell transplant from April 2017 to April 2018. Respiratory viral infection rates, implementation of screening respiratory viral/influenza panels both pre- and post-transplant, and all other values were determined through standard statistical analysis. ‘Treatments’ included any additional medical intervention related to the viral infection of the patient. ‘Significant outcomes’ included any delay in transplant date, death, or hospitalization of any length in time related to the viral illness. Pre-transplantation screening tests were not considered if they occurred more than 16 weeks prior to transplant date.
Results: 89 patients received a HSCT between April 2017 to April 2018, of which 87 patients were assessed in this study. Out of those 87 patients, 41 received an RVP and 48 received an influenza panel pre-transplant. Of both RVP and influenza tested patients, 11 had a positive test result of which 5 required treatment. Post-transplant, 77 patients received an RVP and 79 patients received an Influenza panel. Of both RVP and influenza tested patients post-transplant, 47 had a positive test result of which 28 required treatment. 14 patients went on to develop a significant outcome related to their viral illness including 2 postponed transplants, 3 deaths, and 10 hospitalizations. 0 patients had a positive RVP or influenza panel while asymptomatic either pre- or post-transplantation.
Conclusions: As screening tests, RVP and influenza panel PCR were ineffective at preventing CRV infection given that 0 patients had a positive test result prior to developing symptoms. However, RVP surveillance should be investigated further in a larger population because the rate of adverse outcomes continues to demonstrate the need for improved prevention of respiratory viral infection.