Treatment stratification of respiratory syncytial virus infection in allogeneic stem cell transplantation - 11/05/19
, Richard Salisbury a, Edmund Watson a, Marcin Lubowiecki a, Bing Tseu a, Nadjoua Maouche a, Katie Jeffery c, Siraj A. Misbah d, Rachel Benamore e, Lara Rowley a, Daja Barton a, Rachel Pawson a, b, Robert Danby a, f, Vanderson Rocha a, b, Andy Peniket aHighlights |
• | RSV infections were common in allogeneic stem cell transplant recipients. |
• | Patients with upper respiratory tract infection recovered without antiviral treatment. |
• | On active monitoring progression of upper respiratory tract infection occurred in 15%. |
• | Oral ribavirin with IVIG was effective and safe for lower respiratory tract infection. |
• | The approach was beneficial in reducing hospitalisation and by using oral ribavirin. |
Summary |
Background |
Due to paucity of evidence to guide management of allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients with respiratory syncytial virus (RSV) infections national and international guidelines make disparate recommendations.
Methods |
The outcomes of allo-HSCT recipients with RSV infection between 2015 and 2017 were assessed using the following treatment stratification; upper respiratory tract infections (URTI) being actively monitored and lower respiratory tract infections (LRTI) treated with short courses of oral ribavirin combined with intravenous immunoglobulin (IVIG, 2 g/kg).
Results |
During the study period 49 RSV episodes were diagnosed (47% URTI and 53% LRTI). All patients with URTI recovered without pharmacological intervention. Progression from URTI to LRTI occurred in 15%. Treatment with oral ribavirin given until significant symptomatic improvement (median 7 days [3–12]) and IVIG for LRTI was generally well tolerated. RSV-attributable mortality was low (2%).
Conclusions |
In this cohort study, we demonstrate that active monitoring of allo-HSCT patients with RSV in the absence of LRTI was only associated with progression to LRTI in 15% of our patients and therefore appears to be a safe approach. Short course oral ribavirin in combination with IVIG was effective and well-tolerated for LRTI making it a practical alternative to aerosolised ribavirin. This approach was beneficial in reducing hospitalisation, saving nursing times and by using oral as opposed to nebulised ribavirin.
Le texte complet de cet article est disponible en PDF.Keywords : Respiratory syncytial virus (RSV) infection, Oral ribavirin, Intravenous immunoglobulin (IVIG), Allogeneic stem cell transplantation
Plan
Vol 78 - N° 6
P. 461-467 - juin 2019 Retour au numéro
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