Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation - a compassionate use experience.
Respiratory syncytial virus (RSV) pneumonia in BMT recipients carries a mortality rate of approximately 50-70% despite ribavirin (Virazole) treatment. In both immunocompetent and immunocompromised animal models, RSV neutralizing antibodies rapidly reduce pulmonary virus load after a single dose. RSV-IGIV (RespiGam) is an IgG immune globulin with high concentrations of RSV neutralizing antibody (>19 200 MU/ml). From June 1991 to February 1996, a compassionate-use protocol using RSV-IGIV for treatment of RSV infections was conducted. Eleven children at multiple centers, mean age 3.3 years (4 months to 9 years), were undergoing BMT and met the protocol criteria. They received a single 1500 mg/kg dose of RSV-IGIV infused over 12 h at a median of 5 days (1-37 days) after RSV symptom onset. Ten of these patients received prior or concurrent aerosolized ribavirin. Serum RSV neutralizing titers were measured in five patients and showed a 3- to 30-fold increase 24 h after RSV-IGIV infusion. Adverse events were mild. One of 11 (9.1%) patients died from their RSV illness (91% RSV survival). In comparison to previously published reports, RSV-IGIV treatment of RSV pneumonia in BMT patients may increase survival above that in such patients treated with ribavirin alone. Bone Marrow Transplantation (2000) 25, 161-165.
DeVincenzo
J P
JP
University of Tennessee, Memphis, TN 38103, USA.
Hirsch
R L
RL
Fuentes
R J
RJ
Top
F H
FH
D000280:Administration, Inhalation; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D009500:Neutralization Tests; D011024:Pneumonia, Viral / Q000276:immunology / Q000628:therapy*; D018357:Respiratory Syncytial Virus Infections / Q000276:immunology / Q000628:therapy*; D012136:Respiratory Syncytial Viruses / Q000276:immunology* / Q000502:physiology; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate; D019562:Viral Load
D000914:Antibodies, Viral; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; C098685:respiratory syncytial virus immune globulin intravenous; D012254:Ribavirin