title: The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management.
abstract: Respiratory syncytial virus (RSV) has been reported to cause severe morbidity and mortality among cancer patients receiving chemotherapy with or without autologous peripheral blood stem cell transplantation (APBSCT). However, little is known about the natural history of this infection in these patients, and current standard practice, aerosolized ribavirin plus intravenous immunoglobulin (IVIG), is extremely expensive, difficult to use, and not supported by controlled clinical trials. The purpose of this observational study was to determine the frequency, seasonality, morbidity, and mortality of RSV infection in a group of cancer patients receiving cytotoxic chemotherapy with neither ribavirin nor IVIG treatment. During the period of October 3, 1997, through October 14, 1998, 190 cancer patients (median age, 58 years; 71 women) underwent viral nasopharyngeal washing prior to chemotherapy. Multiple myeloma (MM) accounted for most patients (147, 77%). RSV was recovered from cultures taken from 71 patients (37%) throughout the year, although more frequently during fall and winter seasons (P <.001) than spring and summer. Serious respiratory complications developed in 19 (27%) of 71 RSV-positive patients versus 24 (20%) of 119 patients whose RSV cultures were negative (P =.384). The presence of renal failure or increased lactate dehydrogenase (LDH) prior to chemotherapy and the development of mucositis were the only predictive factors for severe respiratory complications. Recovery of RSV from nasopharyngeal washings among cancer patients is common, occurs throughout the year, and does not appear to increase serious morbidity or mortality. RSV infection may not necessarily be a contraindication for APBSCT or an indication for therapy with aerosolized ribavirin and IVIG.
authors.affiliation: Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock 72205, USA. anaissieeliasj@uams.edu
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: Tahsine H
authors.initials: TH
authors.lastname: Mahfouz
authors.forename: Turan
authors.initials: T
authors.lastname: Aslan
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pouli
authors.forename: Rahman
authors.initials: R
authors.lastname: Desikan
authors.forename: Athanasios
authors.initials: A
authors.lastname: Fassas
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001826:Body Fluids / Q000821:virology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007770:L-Lactate Dehydrogenase / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy* / Q000821:virology; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy* / Q000821:virology*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000473:pathology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D012136:Respiratory Syncytial Viruses / Q000378:metabolism*; D012254:Ribavirin / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D012254:Ribavirin; D007770:L-Lactate Dehydrogenase