Recipients of hematopoietic cell transplants (HCT), a form of stem cell transplant, are at high risk for secondary complications from many infections due to their immunocompromised state following the procedure. For instance, influenza in HCT recipients often progresses to lower respiratory tract disease (LRD) and decreased oxygen content in the blood (hypoxemia), which have high morbidity and mortality. Although influenza treatments are well studied in immunocompetent populations, studying their effects in HCT recipients is difficult. Some researchers believe that corticosteroids, a class of anti-inflammatory drugs, could help reduce risks from the flu. However, previous studies have found conflicting results, suggesting that the drugs might cause additional harm due to delaying viral clearance. Similarly, although antiviral therapy is recommended based on trials in immunocompetent populations, there have been very few studies of its effects in HCT recipients.
VIDD post-doctoral fellow Alexandre Boudreault, along with VIDD affiliate investigator Janet Englund, VIDD co-director Lawrence Corey, VIDD member Michael Boeckh and colleagues, performed a retrospective analysis of 20 years of data on flu outcomes in Hutchinson Center HCT recipients, comparing the outcomes of patients who were concurrently receiving corticosteroids for graft-vs.-host-disease to those who were not. Through statistical modeling, they found that corticosteroid treatment (at any dose) had no effect on the likelihood of developing LRD or hypoxemia, but confirmed previous observations that patients on high-dose corticosteroids have prolonged viral shedding. Thus there is little risk in continuing corticosteroid treatment in flu-infected HCT patients if necessary for treating other conditions, although it has no benefits as a treatment for flu. The researchers also found that antiviral therapy was associated with fewer cases of LRD and fewer episodes of hypoxemia, indicating that it is an effective treatment regimen in this population.
Boudreault AA, Xie H, Leisenring W, Englund J, Corey L, Boeckh M. Impact of Corticosteroid Treatment and Antiviral Therapy on Clinical Outcomes in Hematopoietic Cell Transplant Patients Infected with Influenza Virus. Biol Blood Marrow Transplant. 2010 Sep 23