The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 24; no. 12; pp. 1315 - 1322
• Main Authors: MCCARTHY, A. J, KINGMAN, H. M, STEWARD, C. G, PAMPHILON, D. H, MARKS, D. I, KELLY, C, TAYLOR, G. S, CAUL, E. O, GRIER, D, MOPPETT, J, FOOT, A. B. M, CORNISH, J. M, OAKHILL, A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.12.1999
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Clinical trials; Genotype; Genotypes; Graft rejection; Graft Survival; Graft vs Host Disease; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Infant; Infections; Intravenous administration; Medical sciences; Myelosuppression; Patients; Radiography, Thoracic; Respiratory syncytial virus; Respiratory Syncytial Virus Infections - drug therapy; Respiratory Syncytial Virus Infections - economics; Respiratory Syncytial Virus Infections - etiology; Respiratory tract; Respiratory tract diseases; Retrospective Studies; Ribavirin; Ribavirin - economics; Ribavirin - therapeutic use; Statistical analysis; Stem cell transplantation; Stem cells; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Transplants; Transplants & implants; Treatment Outcome; Viruses; Xenografts; Human; Prognosis; Intravenous administration; Respiratory disease; Retroviridae; Homograft; Genotype; Nebulization; Spumavirinae; Respiratory system; Ribavirin; Infection; Virus; Chemotherapy; Treatment; Human syncytial virus; Viral disease; Bone marrow; Genetics; Antiviral; Complication; Graft
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702078

Respiratory syncytial virus (RSV) is known to cause acute lung injury in the immunocompromised host, especially recipients of bone marrow allografts. Specific prognostic factors for the development of severe life-threatening disease remain to be identified as does the optimum treatment of established disease. Over a 5-year period the incidence and outcome of RSV in BMT recipients was analysed retrospectively. Prognostic factors assessed included type of transplant, engraftment status at the time of infection, the presence of lower respiratory tract disease, viral genotype and treatment received. During the study period, 26 of 336 (6.3%) allogeneic stem-cell recipients were identified as having RSV. Five patients (19.2%) died as a direct result of RSV. One patient died secondary to an intracranial bleed with concomitant RSV. There were four patients with graft failure (two primary and two secondary) attributable to the presence of RSV, two of whom subsequently died of infections related to prolonged myelosuppression. The presence of lower respiratory tract infection and a poor overall outcome was the only statistically significant association. Unrelated donor transplants and AML as the underlying disease appeared to be associated with a poorer outcome. Engraftment status, viral genotype and RSV treatment received did not correlate with outcome. We conclude that future studies are required to identify early sensitive and reproducible prognostic factors of RSV in the immunocompromised host. The roles of intravenous and nebulised ribavirin need to be clarified by prospective controlled trials.