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Human metapneumovirus infection in a hematopoietic transplant recipient

Bone Marrow Transplantation volume 40, pages 699–700 (2007)Cite this article

Recently, a new paramyxovirus with worldwide distribution, designated as human metapneumovirus (hMPV), has been implicated in 5–10% of respiratory infections in immunocompetent children and adults.1 The clinical manifestations are similar to that of human respiratory syncytial virus (hRSV), and range from mild upper respiratory symptoms to severe bronchiolitis and pneumonia. Little is known about the clinical significance of hMPV after hematopoietic stem cell transplantation (HSCT).2 A retrospective analysis of bronchoalveolar lavage (BAL) fluid and lung tissue in 163 HSCT patients identified hMPV in 3 and 3.8% of samples respectively as determined by PCR amplification.3 All five patients had a fatal outcome.

We now report the first successful treatment of hMPV pneumonia in an HSCT recipient. A 55-year-old male with stage IV follicular lymphoma with large cell transformation and refractory relapse received a 6/6 HLA-matched unrelated allogeneic transplant with fully ablative conditioning, comprising cyclophosphamide (60 mg/kg × 2), total body irradiation (1200 cGY) and alemtuzumab (10 mg × 3). We infused 1.78 × 106/kg peripheral blood CD-34+ stem cells and gave tacrolimus for prophylaxis of GVHD. Neutrophil and platelet engraftment was on days 17 and 13 respectively, with 100% donor chimerism. Grade III acute GVHD developed on day 20 involving skin (grade II), gut (grade III) and liver (grade II). Prednisone (2 mg/kg/day) treatment was followed by infliximab (10 mg/kg twice a week × 4 doses) and gradual steroid tapering. At day 94, he developed exacerbation of his skin, liver and gut GVHD, which was successfully treated with rituximab (375 mg/m2 weekly × 4 doses). The patient was maintained on prednisone 15–20 mg/day and tacrolimus (1 mg/day) for non-progressive chronic extensive GVHD involving skin and gut.

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Authors and Affiliations

  1. Center for Cell and Gene Therapy, Baylor College of Medicine, The Methodist Hospital, Houston, TX, USA

    R T Kamble, C Bollard & G Carrum

  2. Diagnostic Virology Laboratory, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA

    G Demmler

  3. Division of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, TX, USA

    P R LaSala

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  1. R T Kamble
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  2. C Bollard
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Correspondence to R T Kamble.

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Kamble, R., Bollard, C., Demmler, G. et al. Human metapneumovirus infection in a hematopoietic transplant recipient. Bone Marrow Transplant 40, 699–700 (2007). https://doi.org/10.1038/sj.bmt.1705781

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