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. 2017 Dec 5;216(10):1235-1244.
doi: 10.1093/infdis/jix390.

Supplemental Oxygen-Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus

Alpana Waghmare  1   2   3   4 , Hu Xie  3 , Louise Kimball  3 , Jessica Yi  3 , Sezen Özkök  3 , Wendy Leisenring  3 , Guang-Shing Cheng  5   3 , Janet A Englund  1   2   4 , Timothy R Watkins  6 , Jason W Chien  6 , Michael Boeckh  5   3
Affiliations

Supplemental Oxygen-Free Days in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus

Alpana Waghmare et al. J Infect Dis. .

Abstract

Background: Clinically meaningful endpoints for respiratory syncytial virus (RSV) treatment trials are lacking for hematopoietic cell transplant (HCT) recipients. We evaluated supplemental oxygen use among HCT recipients with RSV infection.

Methods: Subjects were grouped according to the presence of upper respiratory tract infection (URTI) without lower respiratory tract infection (LRTI), URTI progressing to LRTI, and LRTI at presentation. LRTI was defined as a positive lower respiratory tract sample with or without radiographic abnormality (defined as proven or probable LRTI, respectively) or a positive upper respiratory tract sample with radiographic abnormality (possible LRTI). Supplemental oxygen-free days were defined as any day while alive after diagnosis of RSV infection during which ≤2 L of supplemental oxygen per minute was received.

Results: Among 230 patients, supplemental oxygen use by day 28 after the first diagnosis of RSV infection was lowest in patients presenting with URTI (31 of 197 [16%]). Supplemental oxygen use was lower in patients with possible LRTI (12 of 45 [27%]) than in those with proven/probable LRTI (29 of 42 [69%]). Patients presenting with proven/probable LRTI had a median of 16 fewer supplemental oxygen-free days than those presenting with URTI (P < .0001). Death only occurred among patients with proven/probable LRTI (11 of 42 [26%]).

Conclusions: Confirmation of RSV infection in the lower respiratory tract provides prognostic information that may help prioritize therapies. Supplemental oxygen-free days as a clinical endpoint may allow smaller sample sizes for trials evaluating RSV antivirals.

Keywords: Respiratory syncytial virus; hematopoietic cell transplant; pneumonia.

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Figures

Figure 1.
Figure 1.
A and B, Unadjusted cumulative incidence curves for time to first use of supplemental oxygen (A) and time to mechanical ventilation (B) at day 28 following initial diagnosis of respiratory syncytial virus (RSV) infection, categorized by group. P < .0001, by the log-rank test (A and B). C and D, Unadjusted cumulative incidence curves for time to first use of supplemental oxygen (C) and time to mechanical ventilation (D) at day 28 following diagnosis of RSV lower respiratory tract infection (LRTI) in groups 2 and 3, categorized by possible versus proven/probable LRTI. P < .0001, by the log-rank rest (C); P = .0003, by the log-rank test (D).
Figure 2.
Figure 2.
Unadjusted Kaplan-Meier curves for overall survival at day 28 for groups 1 and 2 versus group 3 following initial diagnosis of respiratory syncytial virus (RSV) infection (P = .0002, by the log-rank test; A), for group 2 versus group 3 following RSV LRTI (P = .514, by the log-rank test; B), and for groups 2 and 3 possible versus groups 2 and 3 proven/probable (the log-rank test could not be performed because of a lack of events in possible group; C).
Figure 3.
Figure 3.
Supplemental oxygen–free days while alive following respiratory syncytial virus (RSV) infection. Bars represent interquartile ranges (IQRs).
See this image and copyright information in PMC

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