- •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.
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.
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Published online: April 12, 2019
Accepted: April 2, 2019
© 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.