Treatment of steroid‐refractory chronic graft‐versus‐host disease with imatinib: Real‐life experience of the Spanish group of hematopoietic transplantation (GETH)

2021 ◽  
Author(s):  
Ingrid Parra Salinas ◽  
Aranzazu Bermudez ◽  
Lucia López Corral ◽  
Oriana Lopez Godino ◽  
Paula Móles‐Poveda ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Life Experience ◽  
Real Life ◽  
Host Disease ◽  
Graft Versus Host ◽  
Hematopoietic Transplantation ◽  
Steroid Refractory

scholarly journals Unmasking viral sequences by metagenomic next-generation sequencing in adult human blood samples during steroid-refractory/dependent graft-versus-host disease

Microbiome ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
M. C. Zanella ◽  
S. Cordey ◽  
F. Laubscher ◽  
M. Docquier ◽  
G. Vieille ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Graft Versus Host Disease ◽  
Rubella Virus ◽  
Viral Infections ◽  
Next Generation ◽  
Host Disease ◽  
Graft Versus Host ◽  
Viral Sequences ◽  
Generation Sequencing ◽  
Steroid Refractory

Abstract Background Viral infections are common complications following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Allo-HSCT recipients with steroid-refractory/dependent graft-versus-host disease (GvHD) are highly immunosuppressed and are more vulnerable to infections with weakly pathogenic or commensal viruses. Here, twenty-five adult allo-HSCT recipients from 2016 to 2019 with acute or chronic steroid-refractory/dependent GvHD were enrolled in a prospective cohort at Geneva University Hospitals. We performed metagenomics next-generation sequencing (mNGS) analysis using a validated pipeline and de novo analysis on pooled routine plasma samples collected throughout the period of intensive steroid treatment or second-line GvHD therapy to identify weakly pathogenic, commensal, and unexpected viruses. Results Median duration of intensive immunosuppression was 5.1 months (IQR 5.5). GvHD-related mortality rate was 36%. mNGS analysis detected viral nucleotide sequences in 24/25 patients. Sequences of ≥ 3 distinct viruses were detected in 16/25 patients; Anelloviridae (24/25) and human pegivirus-1 (9/25) were the most prevalent. In 7 patients with fatal outcomes, viral sequences not assessed by routine investigations were identified with mNGS and confirmed by RT-PCR. These cases included Usutu virus (1), rubella virus (1 vaccine strain and 1 wild-type), novel human astrovirus (HAstV) MLB2 (1), classic HAstV (1), human polyomavirus 6 and 7 (2), cutavirus (1), and bufavirus (1). Conclusions Clinically unrecognized viral infections were identified in 28% of highly immunocompromised allo-HSCT recipients with steroid-refractory/dependent GvHD in consecutive samples. These identified viruses have all been previously described in humans, but have poorly understood clinical significance. Rubella virus identification raises the possibility of re-emergence from past infections or vaccinations, or re-infection.

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