PMID- 35764288
OWN - NLM
STAT- MEDLINE
DCOM- 20220830
LR  - 20220923
IS  - 2666-6367 (Electronic)
IS  - 2666-6367 (Linking)
VI  - 28
IP  - 9
DP  - 2022 Sep
TI  - Clinical and Economic Burden of Multiple Double-Stranded DNA Viral Infections 
      after Allogeneic Hematopoietic Cell Transplantation.
PG  - 619.e1-619.e8
LID - S2666-6367(22)01407-5 [pii]
LID - 10.1016/j.jtct.2022.06.016 [doi]
AB  - Conditioning regimens for allogeneic hematopoietic cell transplantation 
      (allo-HCT) are immunosuppressive and increase the risk for reactivation of and 
      infection with double-stranded DNA (dsDNA) viruses, which contribute to morbidity 
      and mortality after allo-HCT. This retrospective observational study evaluated 
      the association of dsDNA viral infections with clinical outcomes, health resource 
      utilization (HRU), and health care reimbursement after allo-HCT. Patients who 
      underwent allo-HCT between 2012 and 2017 were identified from a US open-source 
      claims database (Decision Resource Group Real-World Evidence Data Repository; 
      n = 13,363) and categorized according to the presence or absence of dsDNA viral 
      infection, defined as having >/=1 diagnosis code for cytomegalovirus (CMV), 
      adenovirus (AdV), human herpesvirus 6 (HHV-6), or BK virus (BKV)/Epstein-Barr 
      virus (EBV)/John Cunningham virus (JCV) (grouped together given a lack of 
      specific diagnoses codes) within 1 year after allo-HCT. Only first allo-HCT data 
      were used in patients who underwent multiple procedures. Study outcomes included 
      clinical outcomes (eg, time to all-cause mortality, new diagnosis of renal 
      impairment), HRU (hospital and intensive care unit length of stay [LOS], 
      readmission rates), and health care reimbursement (total, inpatient, and 
      outpatient costs as reported reimbursements from insurance claims). For all 
      outcomes, patients were stratified by the presence/absence of any dsDNA viral 
      infection and number (none, 1, 2, or >/=3) and type(s) of infection. The effect of 
      graft-versus-host disease (GVHD) was assessed as well. Twenty-nine percent of 
      patients were diagnosed with CMV, 13% with BKV/EBV/JCV, 5% with AdV, and 4% with 
      HHV-6 in the year following their first allo-HCT. A single dsDNA viral infection 
      was documented in 30% of individuals, 2 in 8%, and >/=3 in 2%. Patients with no 
      viral infections had an overall hospital LOS (index hospitalization plus 
      readmissions) of 41.3 days and a total health care reimbursement of $266,345. 
      These numbers increased for every additional viral infection, regardless of the 
      presence or absence of GVHD; the overall hospital LOS was 61.4 days and total 
      healthcare reimbursement was $431,614 in patients with 1 viral infection, 77.0 
      days and $639,097 in patients with 2 viral infections, and 103.3 days and 
      $964,378 in patients with >/=3 viral infections. An increase in the number of dsDNA 
      viral infections was associated with a significantly higher adjusted hazard of 
      all-cause mortality (1 versus 0 dsDNA viral infections: hazard ratio [HR], 1.5; 
      [95% confidence interval (CI), 1.3 to 1.6]; 2 versus 0: HR, 2.0 [95% CI, 1.7 to 
      2.3]; >/=3 versus 0: HR, 2.4 [95% CI, 1.8 to 3.3]) and a significantly higher 
      incidence of new diagnosis of renal impairment, regardless of the presence of 
      GVHD (35% of patients with >/=3 infections, 31% of patients with 2 infections, 26% 
      of patients with 1 infection, and 19% of patients with no infection). These 
      results indicate that more directed prevention and treatment strategies for dsDNA 
      viral infections could substantially improve clinical outcomes and reduce HRU.
CI  - Copyright (c) 2022 The American Society for Transplantation and Cellular Therapy. 
      Published by Elsevier Inc. All rights reserved.
FAU - Hill, Joshua A
AU  - Hill JA
AD  - Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Allergy 
      and Infectious Diseases, University of Washington, Seattle, Washington. 
      Electronic address: Jahill3@fredhutch.org.
FAU - Moon, Seung Hyun
AU  - Moon SH
AD  - AlloVir, Inc, Cambridge, Massachusetts.
FAU - Chandak, Aastha
AU  - Chandak A
AD  - Certara, New York, New York.
FAU - Zhang, Zhiji
AU  - Zhang Z
AD  - Certara, New York, New York.
FAU - Boeckh, Michael
AU  - Boeckh M
AD  - Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Allergy 
      and Infectious Diseases, University of Washington, Seattle, Washington.
FAU - Maziarz, Richard T
AU  - Maziarz RT
AD  - Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20220625
PL  - United States
TA  - Transplant Cell Ther
JT  - Transplantation and cellular therapy
JID - 101774629
RN  - 9007-49-2 (DNA)
SB  - IM
MH  - *Adenoviridae Infections
MH  - *BK Virus
MH  - Cytomegalovirus
MH  - *Cytomegalovirus Infections
MH  - DNA
MH  - *Epstein-Barr Virus Infections
MH  - Financial Stress
MH  - *Graft vs Host Disease
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Herpesvirus 4, Human
MH  - *Herpesvirus 6, Human
MH  - Humans
MH  - *Virus Diseases
EDAT- 2022/06/29 06:00
MHDA- 2022/08/31 06:00
CRDT- 2022/06/28 19:26
PHST- 2022/03/17 00:00 [received]
PHST- 2022/05/27 00:00 [revised]
PHST- 2022/06/16 00:00 [accepted]
PHST- 2022/06/29 06:00 [pubmed]
PHST- 2022/08/31 06:00 [medline]
PHST- 2022/06/28 19:26 [entrez]
AID - S2666-6367(22)01407-5 [pii]
AID - 10.1016/j.jtct.2022.06.016 [doi]
PST - ppublish
SO  - Transplant Cell Ther. 2022 Sep;28(9):619.e1-619.e8. doi: 
      10.1016/j.jtct.2022.06.016. Epub 2022 Jun 25.