title: The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation.
abstract: Respiratory syncytial virus (RSV) is known to cause acute lung injury in the immunocompromised host, especially recipients of bone marrow allografts. Specific prognostic factors for the development of severe life-threatening disease remain to be identified as does the optimum treatment of established disease. Over a 5-year period the incidence and outcome of RSV in BMT recipients was analysed retrospectively. Prognostic factors assessed included type of transplant, engraftment status at the time of infection, the presence of lower respiratory tract disease, viral genotype and treatment received. During the study period, 26 of 336 (6.3%) allogeneic stem-cell recipients were identified as having RSV. Five patients (19.2%) died as a direct result of RSV. One patient died secondary to an intracranial bleed with concomitant RSV. There were four patients with graft failure (two primary and two secondary) attributable to the presence of RSV, two of whom subsequently died of infections related to prolonged myelosuppression. The presence of lower respiratory tract infection and a poor overall outcome was the only statistically significant association. Unrelated donor transplants and AML as the underlying disease appeared to be associated with a poorer outcome. Engraftment status, viral genotype and RSV treatment received did not correlate with outcome. We conclude that future studies are required to identify early sensitive and reproducible prognostic factors of RSV in the immunocompromised host. The roles of intravenous and nebulised ribavirin need to be clarified by prospective controlled trials.
authors.affiliation: Bone Marrow Transplant Unit, Bristol Royal Hospital for Sick Children, United Bristol Healthcare Trust, Bristol, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: McCarthy
authors.forename: H M
authors.initials: HM
authors.lastname: Kingman
authors.forename: C
authors.initials: C
authors.lastname: Kelly
authors.forename: G S
authors.initials: GS
authors.lastname: Taylor
authors.forename: E O
authors.initials: EO
authors.lastname: Caul
authors.forename: D
authors.initials: D
authors.lastname: Grier
authors.forename: J
authors.initials: J
authors.lastname: Moppett
authors.forename: A B
authors.initials: AB
authors.lastname: Foot
authors.forename: J M
authors.initials: JM
authors.lastname: Cornish
authors.forename: A
authors.initials: A
authors.lastname: Oakhill
authors.forename: C G
authors.initials: CG
authors.lastname: Steward
authors.forename: D H
authors.initials: DH
authors.lastname: Pamphilon
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005838:Genotype; D006085:Graft Survival; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D013902:Radiography, Thoracic; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000191:economics / Q000209:etiology*; D012189:Retrospective Studies; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D012254:Ribavirin