Treatment stratification of respiratory syncytial virus infection in allogeneic stem cell transplantation.
Administration, Oral
Adult
Aged
Antiviral Agents
/ therapeutic use
Cohort Studies
Disease Management
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Immunoglobulins, Intravenous
/ therapeutic use
Middle Aged
Practice Guidelines as Topic
Respiratory Syncytial Virus Infections
/ drug therapy
Respiratory Tract Infections
/ classification
Ribavirin
/ therapeutic use
Risk Factors
Transplantation, Homologous
/ adverse effects
Treatment Outcome
Young Adult
Allogeneic stem cell transplantation
Intravenous immunoglobulin (IVIG)
Oral ribavirin
Respiratory syncytial virus (RSV) infection
Journal
The Journal of infection
ISSN: 1532-2742
Titre abrégé: J Infect
Pays: England
ID NLM: 7908424
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
16
12
2018
revised:
07
03
2019
accepted:
02
04
2019
pubmed:
10
4
2019
medline:
16
7
2020
entrez:
10
4
2019
Statut:
ppublish
Résumé
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. 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). 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%). 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.
Sections du résumé
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.
Identifiants
pubmed: 30965067
pii: S0163-4453(19)30116-1
doi: 10.1016/j.jinf.2019.04.004
pii:
doi:
Substances chimiques
Antiviral Agents
0
Immunoglobulins, Intravenous
0
Ribavirin
49717AWG6K
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
461-467Informations de copyright
Copyright © 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.