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. 2013 Aug;68(8):1872-80.
doi: 10.1093/jac/dkt111. Epub 2013 Apr 9.

Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections

Dimpy P Shah  1 , Shashank S Ghantoji, Jharna N Shah, Katia K El Taoum, Ying Jiang, Uday Popat, Chitra Hosing, Gabriela Rondon, Jeffrey J Tarrand, Richard E Champlin, Roy F Chemaly
Affiliations

Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections

Dimpy P Shah et al. J Antimicrob Chemother. 2013 Aug.

Abstract

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.

Keywords: RSV; immunocompromised; pneumonia; stem cell transplantation.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier failure curves for progression to RSV LRTI in 237 patients presenting with URTI, stratified by ribavirin-based antiviral therapy at the URTI stage and year of RSV diagnosis. Antiviral therapy indicates ribavirin-based antiviral therapy at the URTI stage. Progression to RSV LRTI was significantly lower in patients receiving ribavirin-based antiviral therapy at the URTI stage compared with those who did not receive it (P < 0.001 for log-rank test). There was no significant difference in outcomes based on the year of RSV diagnosis (based on log-rank test).
Figure 2.
Figure 2.
Kaplan–Meier failure curves for all-cause mortality, stratified by ribavirin-based therapy at the URTI stage. Antiviral therapy indicates ribavirin-based antiviral therapy at the URTI stage. All-cause mortality was significantly lower in patients receiving ribavirin-based therapy at the URTI stage compared with those who did not receive it (P < 0.05 for log-rank test). There was no significant difference in outcomes based on the year of RSV diagnosis (based on log-rank test); stratification by this variable is not shown in the graph.
Figure 3.
Figure 3.
Outcomes of all RSV infections in allo-HSCT recipients, stratified by the type of antiviral therapy at the URTI stage. R, ribavirin; P, palivizumab; Death, RSV-associated mortality.
See this image and copyright information in PMC

References

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