Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections
Open Access
- 9 April 2013
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 68 (8), 1872-1880
- https://doi.org/10.1093/jac/dkt111
Abstract
Respiratory syncytial virus (RSV) infections are well recognized as a significant cause of morbidity and mortality in allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients. We evaluated the spectrum of clinical manifestations, management (including ribavirin-based antiviral therapy) and outcomes of RSV infections and determined the risk factors associated with RSV lower respiratory tract infection (LRTI) and all-cause mortality. In this retrospective study, we analysed clinical data from all laboratory-confirmed RSV infections in allo-HSCT recipients (n = 280) who presented at our institution from January 1996 to May 2009. Of the 280 patients, 80 (29%) developed LRTI within 20 days (median 1 day, range 0–19 days) and 44 (16%) died within 90 days (median 26 days, range 1–82 days) from RSV diagnosis. Multivariable logistic regression analyses identified several significant risk factors associated with RSV LRTI and all-cause mortality, including age, male sex, neutropenia, lymphocytopenia and lack of ribavirin-based antiviral therapy at the upper respiratory tract infection (URTI) stage. Aerosolized ribavirin-based therapy at the URTI stage was the single most significant factor in reducing the risk of RSV LRTI (83%), all-cause mortality (57%) and RSV-associated mortality (87%) in these patients (P < 0.05), irrespective of the year of RSV diagnosis. Our results demonstrate that RSV infections are a significant cause of morbidity and mortality in high-risk allo-HSCT recipients and ribavirin-based antiviral therapy at the URTI stage had a positive impact on both outcomes in this vulnerable population with multiple risk factors.Keywords
This publication has 23 references indexed in Scilit:
- Management of RSV infections in adult recipients of hematopoietic stem cell transplantationBlood, 2011
- Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantationHaematologica-The Hematology Journal, 2009
- Respiratory Syncytial Virus Infection in Patients with Hematological Diseases: Single-Center Study and Review of the LiteratureClinical Infectious Diseases, 2008
- Randomized Controlled Multicenter Trial of Aerosolized Ribavirin for Respiratory Syncytial Virus Upper Respiratory Tract Infection in Hematopoietic Cell Transplant RecipientsClinical Infectious Diseases, 2007
- Respiratory Viral Infections in Adults With Hematologic Malignancies and Human Stem Cell Transplantation RecipientsMedicine, 2006
- Prospective Study of the Incidence, Clinical Features, and Outcome of Symptomatic Upper and Lower Respiratory Tract Infections by Respiratory Viruses in Adult Recipients of Hematopoietic Stem Cell Transplants for Hematologic MalignanciesTransplantation and Cellular Therapy, 2005
- RESPIRATORY TRACT VIRAL INFECTIONS IN BONE MARROW TRANSPLANT PATIENTSTransplantation, 2003
- Respiratory virus infections in stem cell transplant patients: The European experienceTransplantation and Cellular Therapy, 2001
- Phase 1 Evaluation of the Respiratory Syncytial Virus–Specific Monoclonal Antibody Palivizumab in Recipients of Hematopoietic Stem Cell TransplantsThe Journal of Infectious Diseases, 2001
- Community Respiratory Virus Infections Among Hospitalized Adult Bone Marrow Transplant RecipientsClinical Infectious Diseases, 1996