Characterising Respiratory Infections in Immune-suppressed Haematology and Transplant Patients
- Research Opportunity
- Medicine and Radiology
- Royal Melbourne Hospital
|Professor Monica Slavin||Monica.Slavin@mh.org.au||Personal web page|
|Dr Michelle Yong||Michelle.Yong@unimelb.edu.au||8559 7991||Personal web page|
Summary Invasive fungal and viral infections are frequent complications in malignant haematology and transplant patients leading to high morbidity and mortality. This project aims to evaluate the host immune response in blood and lung through a prospective clinical study at the Royal Melbourne Hospital
Invasive fungal infections (IFI) can complicate up to 10% of stem cell transplants, 25% of acute myeloid leukemia (AML) and is associated with up to 85% mortality 5,6,11,12. The current diagnostic workup of IFIs is challenging and often imprecise. Viral respiratory infections, such as rhinovirus, respiratory syncytial virus (RSV) and influenza virus occur in up to 15% of stem cell transplant recipients 13 and similarly have corresponding high morbidity and mortality 14,15. During the Victorian H1N1 influenza pandemic, it was patients who had pre-existing haematological malignancy which accounted for 50% of all deaths 16. There is an unmet clinical need for accurate diagnostic tools to help differentiate between viral and fungal infective causes and also from non-infective respiratory aetiologies.
New approaches using the immune response
A novel and innovative approach to this problem would be to evaluate the host immune system by measuring individual peripheral blood and bronchoalveolar lavage (BAL) fluid cytokines and immune cell phenotype (Aim 1). This host immune profile, in addition to the current diagnostic techniques may further expand our knowledge to help differentiate and predict lower respiratory tract infections from non-infectious causes (Aim 2)17. The clinical impact of immune cell changes and how it relates to mortality has also not been assessed (Aim 3).
Impact on patient quality of life
Patients who experience lower respiratory tract illness of diagnostic uncertainty whilst undergoing treatment for haematological malignancy or HSCT may have persistent symptoms affecting their quality of life such as breathlessness, fatigue, anxiety and inability to return to work. This impact on patient quality of life has not previously been addressed and will be the focus of Aim 4.
This novel project aims to evaluate the host immune system in malignant haematology and HSCT recipients who undergo diagnostic bronchoscopy for lower respiratory tract disease. The project will characterise the immune cell type and cytokine profile in blood and BAL fluid in order to predict infectious and non-infectious aetiology and to better understand the underlying pathogenesis. Participants from the Royal Melbourne Hospital who are undergoing diagnostic bronchoscopy will be recruited and samples will be tested using flow cytometry and multiplex cytokine array. This project addresses the unmet clinical need to better predict and understand respiratory tract viral and fungal infections in immune-compromised patients with haematological malignancy. The overall project aim is to reduce the morbidity and mortality associated with respiratory infections through immune based diagnosis.
Faculty Research Themes
School Research Themes
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