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. 2014 May 22;123(21):3263-8.
doi: 10.1182/blood-2013-12-541359. Epub 2014 Apr 3.

Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections

Dimpy P Shah  1 , Shashank S Ghantoji  1 , Ella J Ariza-Heredia  1 , Jharna N Shah  2 , Katia K El Taoum  1 , Pankil K Shah  3 , Lior Nesher  1 , Chitra Hosing  4 , Gabriela Rondon  4 , Richard E Champlin  4 , Roy F Chemaly  1
Affiliations

Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections

Dimpy P Shah et al. Blood. .

Abstract

We developed an immunodeficiency scoring index for respiratory syncytial virus (ISI-RSV) infection, based on a cohort of 237 allogeneic hematopoietic cell transplant (allo-HCT) recipients, that can predict the risk of progression to lower respiratory tract infection (LRTI) and RSV-associated mortality. A weighted index was calculated using adjusted hazard ratios for immunodeficiency markers. Based on the ISI-RSV (range, 0-12), patients were stratified into low (0-2), moderate (3-6), and high (7-12) risk groups. A significant trend of increasing incidence of LRTI and RSV-associated mortality was observed as the risk increased from low to moderate to high (P < .001). Patients in the high-risk group had the greatest benefit of ribavirin-based therapy at the upper respiratory tract infection stage and the highest risk for progression to LRTI and death when antiviral therapy was not given (6.5 [95% confidence interval (CI), 1.8-23.6] and 8.1 [95% CI, 1.1-57.6], respectively). The ISI-RSV is designed to stratify allo-HCT recipients with RSV infection into groups according to their risk for progression to LRTI and RSV-associated mortality. Identification of high-risk groups using this index would distinguish patients who would benefit the most from antiviral therapy, mainly with aerosolized ribavirin. The ISI-RSV should be validated in a multi-institutional study.

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Figures

Figure 1
Figure 1
Kaplan-Meier failure curves for progression from RSV URTI to LRTI stratified according to ISI-RSV risk group and antiviral therapy at the URTI stage.
Figure 2
Figure 2
Kaplan-Meier failure curves for RSV-associated mortality stratified according to ISI-RSV risk group and antiviral therapy at the URTI stage. No deaths were observed in the low-risk group, regardless of whether they received antiviral therapy at the URTI stage; hence the 2 lines for this group overlap.
Figure 3
Figure 3
Kaplan-Meier failure curves for RSV-associated mortality in patients presenting with RSV-LRTI stage stratified according to ISI-RSV risk group. Only 2 LRTI patients in the low-risk group did not receive antiviral therapy and no death was observed in this group (data not shown in the figure).
See this image and copyright information in PMC

References

    1. Shah JN, Chemaly RF. Management of RSV infections in adult recipients of hematopoietic stem cell transplantation. Blood. 2011;117(10):2755–2763. - PubMed
    1. Shah DP, Ghantoji SS, Shah JN, et al. Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections. J Antimicrob Chemother. 2013;68(8):1872–1880. - PMC - PubMed
    1. Martino R, Porras RP, Rabella N, et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant. 2005;11(10):781–796. - PMC - PubMed
    1. Schiffer JT, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M. Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantation. Haematologica. 2009;94(8):1101–1108. - PMC - PubMed
    1. Chemaly RF, Ghosh S, Bodey GP, et al. Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center. Medicine (Baltimore) 2006;85(5):278–287. - PubMed

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