BACKGROUND: Human metapneumovirus (hMPV) epidemiology, clinical characteristics and risk factors for poor outcome after allogeneic stem cell transplantation (allo-HCT) remain a poorly investigated area. METHODS: This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allo-HCT. RESULTS: We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS: These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.

Antwerp University Hospital Edegem Belgium

Azienda Ospedaliera Universitaria Integrata Verona Verona Italy

Centre Hospitalier Universitaire de Liege Liege Belgium

Department for Stem Cell Transplantation University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Cellular Therapy and Allogeneic Stem Cell Transplantation Karolinska Comprehensive Cancer Center Karolinska University Hospital Huddinge Stockholm Sweden

Department of Internal Medicine 1 Ordensklinikum Linz Elisabethinen Johannes Kepler University Linz Austria

Department of Internal Medicine 3 University Hospital of Ulm Ulm Germany

Department of Medicine Huddinge Karolinska Institutet Stockholm Sweden

Department of Medicine University of Valencia Valencia Spain

Department of Oncology King Abdulaziz Medical City Ministry of National Guard Health Affairs Riyadh Saudi Arabia

Department of Pediatric Oncology Hematology and Hematopoietic Cell Transplantation University of Medical Sciences Poznan Poland

Dipartimento di Diagnostica per Immagini Radioterapia Oncologica e EmatologiaGemelli Research Institute Fondazione Policlinico Universitario Agostino Gemelli Research Institute Roma Italy

Division for Stem Cell Transplantation Immunology and Intensive Care Medicine Department for Pediatrics and Adolescent Medicine University Hospital Goethe University Frankfurt Germany

Division of Infectious Diseases Dipartimento di scienze della salute University of Genoa Genova Italy

Faculty of Medicine Hebrew University of Jerusalem Hadassah Medical Center Jerusalem Israel

Fundación INCLIVA Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain

Hannover Medical School Hannover Germany

Hematology Department Birmingham Children's Hospital Birmingham United Kingdom

Hematology Department Comprehensive Cancer Center Helsinki University Central Hospital Helsinki Finland

Hematology Department Erasmus Medical Center Cancer Institute Rotterdam The Netherlands

Hematology Department Ghent University Hospital Gent Belgium

Hematology Department Hospital Clinic Barcelona Spain

Hematology Department Hospital Clinico Universitario de Salamanca Salamanca Spain

Hematology Department Hospital Clinico Universitario de Valencia Valencia Spain

Hematology Department Hospital de la Princesa Madrid Spain

Hematology Department Hospital de la Santa Creu 1 Sant Pau Barcelona Spain

Hematology Department Hospital Morales Meseguer Murcia Spain

Hematology Department Hospital Regional de Málaga Malaga Spain

Hematology Department Hospital Universitario Sanitas La Zarzuela Madrid Spain

Hematology Department Leicester Royal Infirmary Leicester United Kingdom

Hematology Department Nottingham University Nottingham United Kingdom

Hematology Department Tor Vergata University of Rome Rome Italy

Hematology Department University Hospital Gasthuisberg Leuven Belgium

Hematology Department University of Freiburg Freiburg Germany

Hematology División Hospital Universitario y Politécnico La Fe Valencia Spain

Infectious Disease Research Program Department of Pediatric Hemtology and Oncology and Center for Bone Marrow Transplantation University Children's Hospital Muenster Germany

Institut Català de Oncología Hospital Duran i Reynals Barcelona Spain

Institution of Hematology Rabin Medical Center Petach Tikva Israel

IRCCS Ospedale Policlinico San Martino Genova Italy

Leiden Study Unit EBMT Leiden The Netherlands

Masaryk University Hospital Brno Brno Czech Republic

Nijmegen Medical Centre Nijmegen The Netherlands

Rambam Medical Center Haifa Israel

Sackler School of Medicine Tel Aviv University Tel Aviv Israel

Service d'Hématologie Clinique et Thérapie Cellulaire Centre Hospitalier Universitaire Bordeaux Bordeaux France

Service d'Hématologie Greffe Hôpital Saint Louis Université Paris Diderot Paris France

The Children`s Hospital at Westmead Sydney Australia

University Medical Center Groningen University of Groningen Groningen The Netherlands

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