Seasonal Human Coronavirus Respiratory Tract Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation

J Infect Dis. 2021 May 20;223(9):1564-1575. doi: 10.1093/infdis/jiaa553.


Background: Little is known about characteristics of seasonal human coronaviruses (HCoVs) (NL63, 229E, OC43, and HKU1) after allogeneic stem cell transplantation (allo-HSCT).

Methods: This was a collaborative Spanish and European bone marrow transplantation retrospective multicenter study, which included allo-HSCT recipients (adults and children) with upper respiratory tract disease (URTD) and/or lower respiratory tract disease (LRTD) caused by seasonal HCoV diagnosed through multiplex polymerase chain reaction assays from January 2012 to January 2019.

Results: We included 402 allo-HSCT recipients who developed 449 HCoV URTD/LRTD episodes. Median age of recipients was 46 years (range, 0.3-73.8 years). HCoV episodes were diagnosed at a median of 222 days after transplantation. The most common HCoV subtype was OC43 (n = 170 [38%]). LRTD involvement occurred in 121 episodes (27%). HCoV infection frequently required hospitalization (18%), oxygen administration (13%), and intensive care unit (ICU) admission (3%). Three-month overall mortality after HCoV detection was 7% in the whole cohort and 16% in those with LRTD. We identified 3 conditions associated with higher mortality in recipients with LRTD: absolute lymphocyte count <0.1 × 109/mL, corticosteroid use, and ICU admission (hazard ratios: 10.8, 4.68, and 8.22, respectively; P < .01).

Conclusions: Seasonal HCoV after allo-HSCT may involve LRTD in many instances, leading to a significant morbidity.

Keywords: seasonal human coronavirus; HCoV-229E; HCoV-HKU1; HCoV-NL63; HCoV-OC43; allogeneic hematopoietic stem cell transplantation; community-acquired respiratory virus; immunocompromised; immunodeficiency score index; multiplex PCR assay; upper and lower respiratory tract disease.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Betacoronavirus
  • Child
  • Child, Preschool
  • Coronavirus 229E, Human
  • Coronavirus Infections / complications*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / mortality
  • Coronavirus NL63, Human
  • Coronavirus OC43, Human
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / etiology*
  • Respiratory Tract Infections / mortality
  • Retrospective Studies
  • Risk Factors
  • Seasons