OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: S Ghosh; R E Champlin; J Englund; S A Giralt; K Rolston; I Raad; K Jacobson; J Neumann; C Ippoliti; S Mallik; E Whimbey Journal: Bone Marrow Transplant Date: 2000-04 Impact factor: 5.483
Authors: R D Harrington; T M Hooton; R C Hackman; G A Storch; B Osborne; C A Gleaves; A Benson; J D Meyers Journal: J Infect Dis Date: 1992-06 Impact factor: 5.226
Authors: A J McCarthy; H M Kingman; C Kelly; G S Taylor; E O Caul; D Grier; J Moppett; A B Foot; J M Cornish; A Oakhill; C G Steward; D H Pamphilon; D I Marks Journal: Bone Marrow Transplant Date: 1999-12 Impact factor: 5.483
Authors: Rodrigo Martino; Rocío Parody Porras; Nuria Rabella; John V Williams; Elena Rámila; Nuria Margall; Rosa Labeaga; James E Crowe; Pedro Coll; Jorge Sierra Journal: Biol Blood Marrow Transplant Date: 2005-10 Impact factor: 5.742
Authors: Sonia M Raboni; Meri B Nogueira; Luine R V Tsuchiya; Gislene A Takahashi; Luciane A Pereira; Ricardo Pasquini; Marilda M Siqueira Journal: Transplantation Date: 2003-07-15 Impact factor: 4.939
Authors: C M Machado; L S Vilas Boas; A V A Mendes; M F M Santos; I F da Rocha; D Sturaro; F L Dulley; C S Pannuti Journal: Bone Marrow Transplant Date: 2003-04 Impact factor: 5.483
Authors: Robert Jordan; Matt Shao; Richard L Mackman; Michel Perron; Tomas Cihlar; Sandy A Lewis; Eugene J Eisenberg; Anne Carey; Robert G Strickley; Jason W Chien; Mark L Anderson; Heather A McEligot; Nicole E Behrens; Laurel J Gershwin Journal: Antimicrob Agents Chemother Date: 2015-06-08 Impact factor: 5.191
Authors: Ajay Sheshadri; Roy F Chemaly; Amin M Alousi; Pankil K Shah; Gabriela Rondon; Lara Bashoura; Joumana Kmeid; Jacques Azzi; David W Blanco; Maryam Kaous; Burton F Dickey; Richard E Champlin; Dimpy P Shah Journal: Biol Blood Marrow Transplant Date: 2018-12-03 Impact factor: 5.742
Authors: Ajay Sheshadri; Mahtab Karimipour; Erik Vakil; Lara Bashoura; Myrna Godoy; Muhammad H Arain; Scott E Evans; Burton F Dickey; David E Ost; Roy F Chemaly; Saadia A Faiz Journal: Transpl Infect Dis Date: 2019-05-28 Impact factor: 2.228
Authors: Sachiko Seo; Hu Xie; Wendy M Leisenring; Jane M Kuypers; Farah T Sahoo; Sonia Goyal; Louise E Kimball; Angela P Campbell; Keith R Jerome; Janet A Englund; Michael Boeckh Journal: Biol Blood Marrow Transplant Date: 2018-08-25 Impact factor: 5.742
Authors: Chikara Ogimi; Elizabeth M Krantz; Jonathan L Golob; Alpana Waghmare; Catherine Liu; Wendy M Leisenring; Christopher R Woodard; Sara Marquis; Jane M Kuypers; Keith R Jerome; Steven A Pergam; David N Fredricks; Mohamed L Sorror; Janet A Englund; Michael Boeckh Journal: Biol Blood Marrow Transplant Date: 2018-05-16 Impact factor: 5.742